Sport Camp Registration
Please fill out the form below for your child to participate in the sports camp July 18-21.
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Student Name *
Age *
T-shirt Size *
Parent Name *
Phone Number *
Name of Insurance Carrier *
Insurance Group Number *
Medical Consent-In presenting my child for diagnosis and treatment, I hereby voluntarily consent to the rendering of such care, including diagnostic procedures, surgical and medical treatment, etc. by authorized members of the hospital staff as may, in their professional judgment be necessary. *
I have read this form and verify that I understand is contents and acknowledge that I (we) are responsible for all reasonable charges in connection with care and treatment of my child. *
Photo Release Permission-As a parent or guardian of this student, I hereby consent to the use of photographs/videotape taken during the course of the camp for publicity, promotional and/or educational purposes (including publications, presentation or broadcast via newspaper, internet, or other media sources). I do this with full knowledge and consent and waive all claims for compensation for use, or for damages. *
Parent Initials *
Date *
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