snow college football camps
SNOW COLLEGE FOOTBALL CAMPS MEDICAL/INSURANCE RELEASE FORM Name of Camper _______________________________
High School ________________________________________
Address _______________________________________
City ________________________ State _____
DOB ____________
Insurance Policy Holder Name ________________________
Phone _____________________
*MUST HAVE COPY OF INSURANCE CARD!* Camp Attending (circle one)
Walk-On Tryout
Zip _______
Insurance Policy Number _____________________________
Team Camp
Individual Camp
Youth Camp
RELEASE AND WAIVER OF CLAIMS In consideration of my child’s/dependent’s participation in the “Snow College Football Camps,” I do hereby, for myself, my child/dependent, my heirs and executors, waive, release and forever discharge all rights and claims for damages and/or injuries for which I or my child/dependent, against “Snow College Football Camps”, employees of Snow College and its agents for any and all injuries and/or damages which may be suffered by my child/dependent in connection with my child’s/dependent’s participation. Parent/Participant Initial ______
PERMISSION FOR MEDICAL ATTENTION The law requires that parental permission be obtained for operative procedures on minors. The parents/guardians need to sign the following consent form so that such procedures may be promptly carried out, and so that no unnecessary delays will occur with operative procedures. However, no operation will be performed, except emergency, without the parents/guardians being contacted and fully informed. I as a parent or legal guardian of (name of camp participant) ______________________, have actual knowledge and appreciation of the particulars of the camp including those risks involved in participation in football camp and hereby voluntarily consent to said minors participation and assume the risks arising there from. With my signature I give my permission for my son/daughter to receive emergency medical procedures deemed necessary. Parent/Participant Initial ______
MEDICAL HISTORY YES A.
Birth deformities (one kidney, etc.)
B.
Medical Conditions currently under treatment
C.
Pre-Existing injury currently under treatment
D.
Fractures or other disability type injuries
E.
Allergy (drugs, food, asthma, etc.)
F.
Mental disorder
G.
Known past illness of more than one weeks duration
H.
Contact Lens or Glasses
I.
Other condition not listed above
NO
Please explain any questions answered “YES”
____________________________________________________________________________ ____________________________________________________________________________ I hereby state the “Snow College Football Camp” is not responsible for any pre-existing injury or illness of the above camper.
INSURANCE RELEASE “Snow College Football Camps” does not carry insurance for injuries, illnesses, etc… sustained during football camp. Campers participate at their own risk. I hereby authorize my son/daughter to participate in the “Snow College Football Camps” under the above medical release/insurance conditions.
___________________________________________
_________________________________________
Participant Name (Please Print)
Participant Signature
___________________________________________
_________________________________________
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date Date
High School ________________________________________
Address _______________________________________
City ________________________ State _____
DOB ____________
Insurance Policy Holder Name ________________________
Phone _____________________
*MUST HAVE COPY OF INSURANCE CARD!* Camp Attending (circle one)
Walk-On Tryout
Zip _______
Insurance Policy Number _____________________________
Team Camp
Individual Camp
Youth Camp
RELEASE AND WAIVER OF CLAIMS In consideration of my child’s/dependent’s participation in the “Snow College Football Camps,” I do hereby, for myself, my child/dependent, my heirs and executors, waive, release and forever discharge all rights and claims for damages and/or injuries for which I or my child/dependent, against “Snow College Football Camps”, employees of Snow College and its agents for any and all injuries and/or damages which may be suffered by my child/dependent in connection with my child’s/dependent’s participation. Parent/Participant Initial ______
PERMISSION FOR MEDICAL ATTENTION The law requires that parental permission be obtained for operative procedures on minors. The parents/guardians need to sign the following consent form so that such procedures may be promptly carried out, and so that no unnecessary delays will occur with operative procedures. However, no operation will be performed, except emergency, without the parents/guardians being contacted and fully informed. I as a parent or legal guardian of (name of camp participant) ______________________, have actual knowledge and appreciation of the particulars of the camp including those risks involved in participation in football camp and hereby voluntarily consent to said minors participation and assume the risks arising there from. With my signature I give my permission for my son/daughter to receive emergency medical procedures deemed necessary. Parent/Participant Initial ______
MEDICAL HISTORY YES A.
Birth deformities (one kidney, etc.)
B.
Medical Conditions currently under treatment
C.
Pre-Existing injury currently under treatment
D.
Fractures or other disability type injuries
E.
Allergy (drugs, food, asthma, etc.)
F.
Mental disorder
G.
Known past illness of more than one weeks duration
H.
Contact Lens or Glasses
I.
Other condition not listed above
NO
Please explain any questions answered “YES”
____________________________________________________________________________ ____________________________________________________________________________ I hereby state the “Snow College Football Camp” is not responsible for any pre-existing injury or illness of the above camper.
INSURANCE RELEASE “Snow College Football Camps” does not carry insurance for injuries, illnesses, etc… sustained during football camp. Campers participate at their own risk. I hereby authorize my son/daughter to participate in the “Snow College Football Camps” under the above medical release/insurance conditions.
___________________________________________
_________________________________________
Participant Name (Please Print)
Participant Signature
___________________________________________
_________________________________________
Parent/Guardian Name (Please Print)
Parent/Guardian Signature
Date Date
