medical waiver form payment options - Sites
MEDICAL WAIVER FORM Release by parents or guardian of athlete
____________________________________ Athlete’s Name
In consideration of the UMHB Elite Football Camp and granting the camper permission to participate, I hereby state that the UMHB Elite Football Camp is not responsible for any pre-existing injury, recurrence of any undisclosed pre-existing injury of the above camper. I further acknowledge and release The University of Mary Hardin-Baylor, The UMHB Elite Football Camp and their officers, employees, contractors, agents, all instructors and all participants in said football camp, from liability, including claims and suits at law or in equity, for injury which may result from the camper taking part in The UMHB Elite Football Camp. I, as a parent or legal guardian, acknowledge and fully understand that the participant will be engaging in activities that involve risk of serious injury. Further, that there may be other risks not known or not reasonably foreseen at this time. I assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death. I hereby consent to said minor’s participation and assume all the risk of his personal injury that may result from the football camp activity. I release, waive, discharge and covenant not to bring legal action upon The University of Mary Hardin-Baylor, The UMHB Elite Football Camp, their officers, employees, contractors, agents, all instructors, all participants and anyone associated with its operation. __________________________________________________________ Signature of Parent or Legal Guardian
Date
Medical Treatment Authorization I/We, being the parents and/or legal guardian of the applicant, authorize The UMHB Elite Football Camp and its agents permission to request emergency medical treatment or care as necessary to ensure the well-being of our dependent and claim that the registrant has had a physical examination deeming him to be fit for all physical endeavors. __________________________________________________________ Signature of Parent or Legal Guardian
Date
PAYMENT OPTIONS $40 Registration Includes: Individual Skills Instruction Technique Drills Camp T-Shirt
Cash or Money Order Only
Address Money Orders to: University of Mary Hardin-Baylor Elite Camp or UMHB Elite Camp.
THE ELITE CAMP • An intense training camp designed for the serious football athlete. • Open to any athlete entering the 11th or 12th grade as of fall, 2015.
INSTRUCTION BY
DATES & LOCATIONS Belton, June 4
University of Mary Hardin-Baylor Crusader Stadium, Registration starts 5 pm
San Antonio, June 5
Madison High School, Registration starts 8 am
Friendswood, June 5
Friendswood High School, Registration starts 5 pm
Spring, June 6
Westfield High School, Registration starts 8 am
Henderson, June 6
Henderson High School, Registration starts 4 pm
Dallas , June 7
LD Bell High School, Registration starts 12 pm
Dallas , June 7
Lake Highlands High School, Registration starts 5 pm
REGISTRATION • Register on location the day of the camp • Bring: Shorts, Cleats, and Medical Waiver Form To reserve your spot at one of our camps, please contact Josh Gonzales at (254) 295-4226 or [email protected].
For more information:
www.cruathletics.com click on Sports Camps
____________________________________ Athlete’s Name
In consideration of the UMHB Elite Football Camp and granting the camper permission to participate, I hereby state that the UMHB Elite Football Camp is not responsible for any pre-existing injury, recurrence of any undisclosed pre-existing injury of the above camper. I further acknowledge and release The University of Mary Hardin-Baylor, The UMHB Elite Football Camp and their officers, employees, contractors, agents, all instructors and all participants in said football camp, from liability, including claims and suits at law or in equity, for injury which may result from the camper taking part in The UMHB Elite Football Camp. I, as a parent or legal guardian, acknowledge and fully understand that the participant will be engaging in activities that involve risk of serious injury. Further, that there may be other risks not known or not reasonably foreseen at this time. I assume all the foregoing risk and accept personal responsibility for the damages following such injury, permanent disability or death. I hereby consent to said minor’s participation and assume all the risk of his personal injury that may result from the football camp activity. I release, waive, discharge and covenant not to bring legal action upon The University of Mary Hardin-Baylor, The UMHB Elite Football Camp, their officers, employees, contractors, agents, all instructors, all participants and anyone associated with its operation. __________________________________________________________ Signature of Parent or Legal Guardian
Date
Medical Treatment Authorization I/We, being the parents and/or legal guardian of the applicant, authorize The UMHB Elite Football Camp and its agents permission to request emergency medical treatment or care as necessary to ensure the well-being of our dependent and claim that the registrant has had a physical examination deeming him to be fit for all physical endeavors. __________________________________________________________ Signature of Parent or Legal Guardian
Date
PAYMENT OPTIONS $40 Registration Includes: Individual Skills Instruction Technique Drills Camp T-Shirt
Cash or Money Order Only
Address Money Orders to: University of Mary Hardin-Baylor Elite Camp or UMHB Elite Camp.
THE ELITE CAMP • An intense training camp designed for the serious football athlete. • Open to any athlete entering the 11th or 12th grade as of fall, 2015.
INSTRUCTION BY
DATES & LOCATIONS Belton, June 4
University of Mary Hardin-Baylor Crusader Stadium, Registration starts 5 pm
San Antonio, June 5
Madison High School, Registration starts 8 am
Friendswood, June 5
Friendswood High School, Registration starts 5 pm
Spring, June 6
Westfield High School, Registration starts 8 am
Henderson, June 6
Henderson High School, Registration starts 4 pm
Dallas , June 7
LD Bell High School, Registration starts 12 pm
Dallas , June 7
Lake Highlands High School, Registration starts 5 pm
REGISTRATION • Register on location the day of the camp • Bring: Shorts, Cleats, and Medical Waiver Form To reserve your spot at one of our camps, please contact Josh Gonzales at (254) 295-4226 or [email protected].
For more information:
www.cruathletics.com click on Sports Camps
