Homeboys Football Camp Registration 2019
Event Timing: July 10th and 11th from 9am-3pm daily
Event Location: Central Valley High School
Contact us at (724) 601-8317 or homeboysfoundation@yahoo.com
Email address *
Homeboys Camp 2019
Participant's Name *
Address *
Phone *
Age *
Child's Football Organization *
Parent/Guardian's Name *
Emergency Contact *
Emergency Contact Phone *
Waiver & Liability -In consideration for my child being permitted to participate in the program, related events and activities, the undersigned acknowledges and agrees that as the natural parent and/or as the legally authorized guardian, do hereby for myself, my spouse, my child agree not to sue and hereby release, waive, discharge, hold harmless and indemnify and forever defend the program administrator, for any and all known or unknown, foreseen or unforeseen, bodily or personal injuries, death and permanent injury, illnesses, damage to property, or other losses, and any consequences thereof, including expenses, costs, and attorney's fees, as may be sustained by my child or me arising out of or in any way associated with my child's participation in the given program, travel incident thereto, whether by negligence or not to the fullest extent permitted by law. The risk of serious injury to my child from these activities does exist including the potential for permanent disability and death. I understand and fully acknowledge that my child's participation in these activities is solely at our own risk and I assume full responsibility. I hereby authorize and give my consent to the staff/volunteers of The Homeboys Football Camp to act on my behalf to secure medical treatment for the administration of all emergency medical and/or emergency surgical treatment that may be necessary for my child. I understand that should an emergency medical problem arise, an attempt will be made to contact me as soon as the staff deems it is medically prudent and safe to do so given the nature of the medical problem. In the event that I cannot be reached, I hereby give consent to such treatment as deemed necessary by a licensed health care professional. I agree to assume all costs related to such treatment. I understand that I will be responsible for any medical or other charges in connection with attendance at this Camp. I authorize the disclosure of medical information to the insurance company listed below for the purpose of any claim. (Each camper must provide his/her own health insurance.) I hereby give my consent to use the likeness and/or name/identity, as well as the use of any and all photographs, videos, audio or any other type of media taken of, produced and/or published of the above-named camper for purposes of promotional materials or any other type of media produced and/or published by The Homeboys Foundation, for promotion or publication of the same. THIS DOCUMENT IS A RELEASE AND WAIVER AND BY SIGNING BELOW, THE PARTIES ACKNOWLEDGE THEY HAVE READ AND FULLY UNDERSTAND THE LANGUAGE CONTAINED HEREIN. *
Signature (Type name Below) *
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