SPORTS CAMP REGISTRATION
MEDICAL RELEASE FORM

(Please click through the information - do not hit your "Enter" key until you are ready to submit your registration.  Thank you.)

Activity:
Soccer        Basketball       Cheerleading

Shirt Size:
YS     YM    YL      AS     AM    AL      AXL   

Name:         Age:       Grade: 

Address:         DOB:             M:   F:

City:     State:    Zip: 

Parent's Name: 

Home Phone:        Cell Phone:

Emergency Contact:     Emer. Phone: 

Allergies: 

Health Issues: 

Medical and Liability Release:

We realize that no activity is without the possibility of unforeseen hazards which could result in injury to an individual.  As a parent or guardian, you are to be aware of your responsibility to instruct your child of the importance of conduct which will ensure safety and an enjoyable time while participating in this activity.  By signing this form, you, as a parent, guardian or other responsibile party, agree to assume the risks and hazards which are inherent in this kind of activity.  You also agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss or injuries to the child for whom you sign.

I further give my permission for the use of any photo or likeness of my child to be used by the sponsoring organizations for their use in promotional materials.

I give my child, , permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment deemed necessary by a licensed physician due to accident or illness during this activity.

Parent's/Guardian Signature:    Date: 
                                                 (Release is granted by the typing of signature in this document)