Camper Registration Form - South Hill
2024 South Hill Summer Youth Camps
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Email *
Camper First and Last Name? *
Year Camper Was Born? *
Phone Number? *

Waiver Agreement *
ASSUMPTION OF RISK AND RELEASE FROM RESPONSIBILITY AGREEMENT
The undersigned represents to US Spokane that he/she is the natural parent or the legal guardian of the above-named participant or that he/she is the above-named participant and is at least 18 years old at time of checking the consent box below.

Release of Liability:
By signing this Release Form, I expressly warrant that the child named above is capable of withstanding both physical and mental demands of the planned activities. I also expressly assume all risks of the child whether such risks known or unknown to me at this time. I further release US Spokane and its employees, volunteers, leaders, and agents from any claim that my child may have against them because of an injury of illness incurred during participation in the activities. This release of liability shall include (without limitation) any claims of negligence or breach of warranty. This release of liability is also intended to cover all claims that members of the child’s or my family or estate heirs, representatives, or assigns may have against US Spokane or its employees, volunteers, or agents.

First Aid & Emergency Medical Treatment:
I do hereby give permission for agents of US Spokane to seek and secure any needed medical attention or treatment for my child including hospitalization. I give permission for attending physician(s) and other medical personnel to administer any needed medical treatment, including surgery. In so doing, I agree to pay all fees and costs arising from the action to obtain medical treatment.

Publicity:
On occasion, US Spokane takes photographs or makes audio/visual recording of children involved in its activities. Such photographs and audio/visual recording may be used in US Spokane’s publications or website. I consent to the use of such audio/visual recording of the child named above to be used, distributed, or displayed, as needed.

I HAVE CAREFULLY READ THIS ASSUMPTION OF RISK, RELEASE OF LIABILITY,
AND RELEASE AGREEMENT AND I FULLY UNDERSTAND ITS CONTENTS. I AM
AWARE THAT THIS IS A RELEASE OF LIABILITY AND A CONTRACT BETWEEN ME
AND US Spokane. I AM CHECKING THIS DOCUMENT OF MY OWN FREE WILL.


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Concussion Guidelines *
Ubuntu Spokane (US) offers the following guidelines and recommendations for related to concussions:
1. If a participant suffers, or is suspected of having suffered a concussion or head injury during a sport competition or practice session, the participant: (1) must be immediately removed from the contest or practice and (2) may not again participate in practice or competition until a health care provider has evaluated the participant and provided a written clearance for the participant to return to practice and competition. Ubuntu Spokane recommends that the participant should not be cleared for practice or competition the same day the concussion consistent sign, symptom or behavior was observed.
2. What are the “signs, symptoms, or behaviors consistent with a concussion”? The National Federation rule lists some of the signs, symptoms, and behaviors consistent with a concussion. The U.S. Department of Human Services, Centers for Disease Control and Prevention has published the following lists of signs, symptoms and behaviors that are consistent with a concussion:
SIGNS OBSERVED BY OTHERS SYMPTOMS REPORTED BY ATHLETE • Appears dazed or stunned • Is confused about assignment • Forgets plays • Is unsure of game, score, or opponent • Moves clumsily • Answers questions slowly • Loses consciousness • Shows behavior or personality changes • Cannot recall events prior to hit • Cannot recall events after hit • Headache • Nausea • Balance problems or dizziness • Double or fuzzy vision • Sensitivity to light or noise • Feeling sluggish • Feeling foggy or groggy • Concentration or memory problems • Confusion These lists may not be exhaustive
3. What is a “Health Care Provider”? A Health care provider to be “a person licensed by the state board of healing arts to practice medicine and surgery.” US understands this means a Medical Doctor (MD) or a Doctor of Osteopathic Medicine (DO).
4. The first step to concussion recovery is cognitive rest. participant may need their academic workload modified or even be completely removed from the classroom setting while they are initially recovering from a concussion as they may struggle with concentration, memory, and organization. participants should also avoid the use of electronic devices (computers, tablets, video games, texting, etc.) and loud noises, as these can also impair the brain’s recovery process. Trying to meet academic requirements too early after sustaining a concussion may exacerbate symptoms and delay recovery. Any academic modifications should be coordinated jointly between the participant’s medical providers and school personnel. No consideration should be given to returning to physical activity until the participant is fully integrated back into the classroom setting and is symptom free. Rarely, a participant will be diagnosed with post- concussive syndrome and have symptoms that last weeks to months. In these cases, a
participant may be recommended to start a non-contact physical activity regimen, but this will only be done under the direct supervision of a healthcare provider.
5. Return to Play or Practice Clearance Requirements:
A. The clearance must be in writing and signed by a health care provider.
B. The National Federation and US recommend the clearance should not be issued on the same day the athlete was removed from play.
C. The National Federation and US recommend that a participant who has been removed from a practice or competition because the participant suffered, or was suspected of suffering, a concussion or head injury should complete a graduated return to play protocol following medical clearance before returning to unrestricted practice or competition. The National Federation has included the following graduated protocol in its Suggested Guidelines for Management of Concussion in Sports. In most cases, the athlete will progress one step each day. The return to activity program schedule may proceed as below following medical clearance:
Step 1: Light aerobic exercise- 5 to 10 minutes on an exercise bike or light jog; no weight lifting, resistance training, or any other exercises.
Step 2: Moderate aerobic exercise- 15 to 20 minutes of running at moderate intensity in the gym or on the field without a helmet or other equipment.
Step 3: Non-contact training drills in full uniform. May begin weight lifting, resistance training, and other exercises.
Step 4: Full contact practice or training.
Step 5: Full game play. If symptoms of a concussion re-occur, or if concussion signs and/or behaviors are observed at any time during the return to activity program, the athlete must discontinue all activity and be re-evaluated by their health care provider.
This is simply a suggested protocol. The appropriate health care provider who issues the written clearance may wish to establish a different graduated protocol.
6. Participants ARE REQUIRED to Sign Concussion & Head Injury Information guidelines upon registering into US prior to the participant participating in any camp.


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