Super Summer Release
This is the online version of the release for your child to attend Super Summer through FBC, Pea Ridge.
JV: June 22-25
SS: June 25-29
Email address *
Participant Name *
Your answer
Emergency Contact (EC) *
Your answer
EC Relation to Participant *
EC Phone Number *
Your answer
Participant Allergies, Medical Conditions, Etc.?
Your answer
Is sponsor authorized to approve medical treatment? *
Is sponsor authorized to administer over-the-counter pain relievers? *
Medical Insurance Co. Name
Your answer
Policy/Group Number
Your answer
By checking "I agree" below, the participant (or parent / guardian, if participant is a minor) acknowledges and accepts the risks of physical injury associated with the participation in the activity described above. Except for gross negligence on the part of the sponsor, the participant, or parent / guardian, promises to hold harmless the sponsoring organization and its representatives for any injury related to the activity. The sponsoring organization is authorized to get medical treatment for the participant if need arises. If a dispute over this agreement of any claim for damages arises, the participant, and parent / guardian agree to resolve the matter through a mutually acceptable arbitration process. *
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