The University of Akron Sport Science Academy E-Forms
2018 Sport Science Academy E-Forms
Email address *
Camper/Junior Counselor Information
Registering my child for *
Required
First Name *
Your answer
Last Name *
Your answer
What weeks are you camping *
Required
Camper Gender *
Camper Age *
Camper Date of Birth *
MM
/
DD
/
YYYY
Camper T-Shirt Size *
Parents Names *
Your answer
Parents Phone Numbers *
Your answer
Home Address *
Your answer
City *
Your answer
State *
Your answer
Zip Code *
Your answer
Please list approved adults for picking up and dropping off your camper(s). (Please list their name, relationship to camper and phone number) *
Your answer
Emergency Contact/Medical Forms, Assumption of Risk Waiver, and Publicity Release Forms BELOW
Emergency Contact Name *
Your answer
Emergency Contact Relationship To Camper *
Your answer
Emergency Contact Phone Number *
Your answer
Secondary Emergency Contact Name
Your answer
Secondary Emergency Contact Relationship To Camper
Your answer
Secondary Emergency Contact Phone Number
Your answer
Camper Allergies (Please List) *
Your answer
Camper Medication Currently Taking (Please List) *
Your answer
Check if known to have any of the following conditions *
Required
Emergency Medical Authorization Form
Please read the following information regarding terms and conditions of The University of Akron Sport Science Academy medical waiver.
Emergency Medical Authorization: I am aware of the risks, hazards, and inherent dangers that may arise due to my child’s participation in the Sport Science Academy - Youth Sport Camp being held at The University of Akron (collectively referred to as “UNIVERSITY”) on June 11-15, 2018, June 18-22, 2018 and June 25-27,2018. In consideration for being allowed to participate in said activity, I hereby release, waive, and discharge the UNIVERSITY, its instructors, agents, and employees from every claim, liability, or demand of any kind sustained, whether caused by the negligence of the UNIVERSITY or otherwise. This release shall be binding upon any heirs, administrators, executors, and assigns of mine. I further agree to indemnify the UNIVERSITY from any loss, liability, damage, or cost it may incur due to my child’s participation in said activity in any way whether caused by the UNIVERSITY or otherwise. In the event of illness or injury resulting or arising directly or indirectly out of said activity, I hereby give my consent and authorization for (1) the administration of emergency first aid care and treatment at the scene of an emergency by faculty, staff members, or volunteers of the UNIVERSITY or (2) the administration of any treatment deemed necessary by a licensed physician or dentist and (3) the transfer to any hospital reasonably accessible. This authorization is not intended to cover major surgery unless the medical opinions of two (2) licensed physicians or dentists, concurring in the necessity for such surgery, are obtained prior to the performance of such surgery. I further declare and warrant that I am covered by sufficient medical and dental insurance and that such insurance will remain in effect during my child’s participation in said activity. *
By typing your name below it will act as your electronic signature that you are acknowledging and agreeing to the terms above. Please Type Your Name Below
Your answer
Assumption of Risks Waiver
Please read the following information regarding terms and conditions of The University of Akron Sport Science Academy subsumption of risks waiver. Read this document completely before signing. Its effect is to release the sponsors and The University of Akron from any liability resulting from your child’s participation in the below named activity and waives all claims for damages or losses against the sponsors and UA.
In consideration of my being permitted to participate in the following activity: Sport Science Academy - Youth Sport Camp at The University of Akron, on June 11th-15th, 2018 and/or June 18th-22nd, 2017. My child exercise’s their own free choice to participate voluntarily in the above named activity, and promising to take due care during such participation, hereby release and discharge, indemnify and hold harmless the Sport Science Academy, the Board of Governors of The University of Akron System, and The University of Akron, and their members, officers, agents, employees, and any other persons or entities acting on behalf, and the successors and assigns for any and all of the aforementioned persons, and entities, against all claims, demands, and causes of action whatsoever, either in law or in equity, relating to injury, disability, death, or other harm, to persons or property of both, arising from my participation in and/or at the above listed activity. I acknowledge that I have been informed of hazards and risks which may be associated with participation in the above-mentioned activity, I understand, accept and assume those hazards and risks, and waive all claims against the Department of Sport Science and Wellness Education, the Board of Governors of The University of Akron System, and The University of Akron, and other persons as set forth above. I understand that I am solely responsible for any costs arising out of any bodily injury or property damage sustained through my participation in normal or unusual acts associated with the above-named activity. I have had sufficient time to review and seek explanation of the provisions contained above, have carefully read them, understand them fully, and agree to be bound by them. After careful deliberation, I voluntarily give my consent and agree to this Release from Responsibility, Assumption of Risk and Waiver. If participant is under the age of 18, his/her parent or legal guardian must also sign: I, parent of guardian of the child listed above is the parent or legal guardian of the participant who has signed above. I have read and understand the provisions of this document; I consent to the participant participating in the activity described above, and fully enter into and agree to the above Release from Responsibility, Assumption of Risk and Waiver. *
By typing your name below it will act as your electronic signature that you are acknowledging and agreeing to the terms above. Please Type Your Name Below
Your answer
Publicity Release Waiver
Please read the following information regarding terms and conditions of The University of Akron Sport Science Academy Publicity Release Waiver.
I authorize The University of Akron to broadcast my child's appearance and/or voice and to record my picture and/or voice (on photographs, film and/or tape), to edit these recordings at its discretion,to incorporate these recordings into a broadcast medium, to use such recordings for publicity and advertising, and to use my name, photograph, likeness, voice, biographic and other information concerning me in connection thereto. I know that The University of Akron owns all rights to the aforementioned recordings, photographs, and biographical materials.I release The University of Akron from any loss, damage and liability arising out of my appearance on photographs, film, printed materials and/or tape. *
Please select your choice below whether or not you consent to the Publicity Waiver
By typing your name below it will act as your electronic signature that you either accept or decline agreement to the Publicity Waiver. Please Type Your Name Below *
Your answer
Getting to know our campers: Camper Profile
This helps us program plan better of what sports to offer
Please list your son or daughter's prior camp experience
Your answer
Please list your son or daughter's Favorite Subject in School
Your answer
Please list your son or daughter's Favorite Food
Your answer
Please list your son or daughter's Favorite Movie
Your answer
Check number your son or daughter feels comfortable with each sport listed (1-Not Comfortable – 4- Very Comfortable)
1-Not Comfortable
2
3
4- Very Comfortable
Flag Football
Baseball/Softball
Basketball
Soccer
Track & Field
Swimming
Tennis
Golf
Bowling
Hockey
Lacrosse
A copy of your responses will be emailed to the address you provided.
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