Jamaica Fencing Volunteer Coach
Event Timing: March 18th, 2017 - March 25, 2017
Event Address: St. George College, Winchester Park, North Street, Kingston, Jamaica W.I.
Contact us at (407) 617-8166 or volunteer@JamaicanFencing.org
Cost: $419.00 USD
Jamaica Fencing Volunteer Corp. Registration Form
Athlete Information
Athlete's Name *
Your answer
Email Address *
Your answer
Phone Number *
Your answer
Birthdate *
MM
/
DD
/
YYYY
High School / University / Fencing Club
Your answer
I would like to participate in peer-to-peer fundraiser to pay camp fee.
I need more information before I commit.
Gender
Dietary restrictions
Parent Guardian Information
* If athlete is a minor
Name
Your answer
Home Number
Your answer
Cell Number
Your answer
Email
Your answer
Emergency Contact
Emergency Contact's Name
Your answer
Relationship
Phone Number
Your answer
Alternate Phone Number
Your answer
Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe.
Your answer
Is the athlete prescribed an inhaler? If yes, please explain any instructions.
Your answer
Informed Consent and Acknowledgement
I hereby give my approval for my child’s participation in any and all activities prepared by JAFA during the selected camp. In exchange for the acceptance of said child’s candidacy by JAFA ., I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless JAFA and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions. In case of injury to said child, I hereby waive all claims against JAFA including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including Fencing.
Medical Release and Authorization
As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed. Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me. Permission is also granted to JAFA and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility. Release authorized on the dates and/or duration of the registered season.This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.