JOIQUE BELL YOUTH FOOTBALL CAMP REGISTRATION AND WAIVER/RELEASE FORM
Email address *
PARENT INFO
PARENT'S FIRST NAME *
Your answer
PARENT'S LAST NAME *
Your answer
CAMP PARTICIPANT
CHILD'S FIRST NAME *
Your answer
CHILD'S LAST NAME *
Your answer
CHILD'S AGE *
Child's T-Shirt Size *
PARENTAL CONSENT
I am the parent or legal guardian of the participant in Joique Bell Youth Football Camp 2019. I hereby grant permission for his/her participation in any and all football camp activities. *
Required
PHOTO/VIDEO RELEASE
I give permission for photographs and/or video taken of my child while participating in Joique Bell Youth Football Camp 2019 to be used in marketing/public relations in the promotion of Joique Bell Youth Football Camp. *
Required
RELEASE FROM LIABILITY
I agree to assume all risks and hazards incidental to participation in Joique Bell Youth Football Camp 2019. I do hereby waive, release, absolve, indemnify, and agree to hold harmless, Joique Bell, National Football League, Detroit Lions, A3 Athletics, Benton Harbor High School, the officers, directors, coaches, sponsors, volunteers, staff, participants, for and from any and all liability for all claims, demands, losses, damages and costs, including reasonable attorney's fees, that arise out of or in connection with any personal injury, property damage, and/or other loss suffered by the child in connection with the child's participation in Joique Bell Youth Football Camp 2019. *
Required
MEDICAL CONSENT
In case of a medical emergency, I give permission for my child to be given emergency treatment including First Aid and CPR by a qualified staff member or volunteer of the Joique Bell Youth Football Camp 2019. I also give my permission for my child to be transported by ambulance, treated by aid car personnel, and/or transported to an emergency center for treatment. In the event I cannot be contacted, I further authorize and consent to the medical, surgical, and hospital care treatment and procedures to be performed for my child by a licensed physician or hospital selected by the Joique Bell Youth Football Camp 2019 when deemed immediately necessary or advisable by the physician to safeguard my child's health. I waive my right of informed consent to such treatment. I certify (or declare) that I am parent or legal guardian of the above named child and that I have authority to authorize such activities and actions. *
Required
ELECTRONIC SIGNATURE AND ACKNOWLEDGEMENT
I acknowledge that I am over the age of 18 and have read the release/waiver form and fully understand its contents and have signed below of my own free will. I also understand that providing my First and Last name constitutes a legal signature confirming that I acknowledge and agree to the above.
Please type your first and last name. *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Privacy Policy