By completing this form, you (a legal parent/guardian of the clinic participant named below) recognize: (1) There are risks of injury or damage resulting from such participation. Any activity involving contact, motion or height creates the possibility of serious injury, including permanent paralysis and even death; (2) There may be costs in the event of such injury or damage and all costs, for the injury or damage and for any insurance against such risks, are the responsibility of the undersigned.
In the event of an injury requiring more than basic first aid, it remains the responsibility of the parent/guardian to make arrangements for medical care and transportation of his/her child. The clinic will make every reasonable effort to contact the parent/guardian in the event of such injury and provide an adult to accompany the injured athlete.
Emergency information is based on the contact information you provide below. You should also notify your physician that he/she is authorized to render care in the event that you cannot be contacted. An ambulance will transport clinic participants with serious injuries to the nearest hospital. The emergency room will not treat your child (except for life threatening injuries) unless a parent/guardian or personal physician gives injury specific approval.