PARENT OR GUARDIAN MUST SIGN. As parent or legal guardian of below participant, I authorize the Xxx Xxxxxxxxxx Girls Basketball Camp to request medical treatment as necessary to insure the well being of the participant. We, the undersigned, for ourselves, or heirs, executors and administrators, waiver and release forever discharge the Xxx Xxxxxxxxxx Girls Basketball Camp, their staff, officers, agents, representatives, employees, successors, and assigns of and from any and all rights claim for damages to person or property which may be sustained or occur during participation in activities, to or from program whether paid damages, injury or loss are due to negligence or not. Camper’s Name (Print) Parent/Guardian Signature Date HEALTH RECORD FOR CHILDREN IN DAY CAMPS & AFTERSCHOOL & YOUTH CENTERS (This side to be filled in by parent before presentation to physician) NAME OF PROGRAM / / M ❑ F ❑ CHILD'S LAST NAME FIRST NAME BIRTHDATE SEX Home Address: Phone: Parent or Guardian: Phone: Place of Employment: Father (Guardian) Phone: Mother (Guardian) Phone: In case of emergency, notify: Phone: If Parent, Guardian are not available in an emergency, notify:
PARENT OR GUARDIAN MUST SIGN. As parent or legal guardian of the participant below, I authorize the Xxx Xxxxxxxxxx Basketball Camp to request medical treatment as necessary to ensure the well-being of the participant. We, the undersigned, for ourselves, or heirs, executors, and administrators, waiver and release forever discharge the Xxx Xxxxxxxxxx Basketball Camp, their staff, officers, agents, representatives, employees, successors and assigns of and from any and all rights claim for damages to persons or personal property which may be sustained or occur during participation in activities, to or from the program whether paid damages, injury or loss are due to negligence or not. Campers Name (Print) Parent/Guardian Signature
PARENT OR GUARDIAN MUST SIGN. As a parent or legal guardian of below participant, I authorize Stargazer Day Camp to request medical treatment as necessary to insure the well being of the participant. We, the undersigned, for ourselves, or heirs, executors and administrators, waiver and release forever discharge Stargazer Day Camp, its owner, staff, officers, agents, representatives, employees, successors, and assigns of and from any and all rights claim for damages to person or property which may be sustained or occur during participation in activities, to or from the camp and program whether paid damages, injury or loss are due to negligence or not. Camper’s Name (Print): Parent/Guardian Signature:
PARENT OR GUARDIAN MUST SIGN. As parent or legal guardian of below participant, I authorize the Blue Collar Basketball Camp to request medical treatment as necessary to insure the well being of the participant. We, the undersigned, for ourselves, or heirs, executors and administrators, waiver and release forever discharge the Blue Collar Basketball Camp, their staff, officers, agents, representatives, employees, successors, and assigns of and from any and all rights claim for damages to person or property which may be sustained or occur during participation in activities, to or from program whether paid damages, injury or loss are due to negligence or not. Camper’s Name (Print) Parent/Guardian Signature
PARENT OR GUARDIAN MUST SIGN. If Volunteer Is Under The Age Of 18 Date Volunteer Must Sign If 18 Years Or Older Date Emergency Treatment My Medical Insurance Carrier is: Name Of Medical Insurance Carrier I understand that every precaution is taken to protect the safety of every volunteer. I agreed to emergency treatment by a physician or hospital in the event I am not able to give permission / I cannot be reached.
