Chris Lamb Volleyball Camp Emily Stockman Clinic

Chris Lamb Volleyball Camp Emily Stockman Clinic Name: ___________________________________________________________________________ Address: _________________________________________________________________________ City, State, ZIP: ____________________________________________________________________ Phone: ____________________ ____Cell ___________________Age as of 1/1/2016_____________ Grade: _____ Email_______________________________________________________________ Participation Agreement and Release for Chris Lamb VB Camp Emily Stockman Clinic (parent/guardian must sign if under 18) In consideration of my participation in the Chris Lamb VB Camp Emily Stockman Clinic, I assume complete responsibility for any injury to me or damage to my property that may occur during the event or while I am on the premises of the event. I verify that I have been checked by a licensed physician and am physically able to participate in the Chris Lamb VB Camp Emily Stockman Clinic. I understand that participation in the Chris Lamb VB Camp Emily Stockman Clinic may include vigorous physical exercise or activity involving a multitude of risks, including but not limited to, broken bones, sprains, muscle pulls and head injuries. I hereby release and hold harmless Wichita State University, The Wichita State University Intercollegiate Athletic Association Inc. (“WSU-ICAA”), their employees and representatives, and any other event sponsors associated with the Chris Lamb VB Camp Emily Stockman Clinic. The State of Kansas, Wichita State University and WSU-ICAA, do not insure against accidents or injury. I understand that I am participating in the Chris Lamb VB Camp Emily Stockman Clinic and using the facilities of WSU-ICAA at my own risk and with knowledge that WSU-ICAA is subject to the Kansas Tort Claims Act. (K.S.A. 75-6101 et. seq.) I grant permission to WSU-ICAA to use any photographs, motion pictures, recordings or any other record of this event for publicity or other legitimate purpose. _____________________________________________________ ___________________ Signature Date _____________________________________________________ ___________________ Parent/Guardian Signature (if Chris Lamb VB Camp Emily Stockman Clinic Participant under 18) Date