Pacific NW HA - Sept. 9-10th 2017 at Bellevue College
*What the registrant types into this form will be used for all further communication for the event as well for any reporting through the West Coast Elite scouting service. Make sure to be accurate with the information and follow the models. Do not type in all caps.
Avoid writing high school after your school name (State High School would be State) and if from OUTSIDE of California, add the state code (e.g. KS) after the school (e.g. State (KS))
Type none if no travel team
GPA (e.g 4.0)
Intended academic major?
Parent name (s)
Parent emails (s)
Separate with commas
Insurance provider and policy number (write none if without)
HEALTH AND BEHAVIOR GUIDELINES AND WAIVER OF LIABILITY
I understand that any participant in any WCE/VSF-related camp, showcase, event, game or trip participant who does not abide by the rules, regulations and policies established by WCE LLC, EWE Teams LLC, WCE LLC, The Alliance LLC or any WCE/EWE-affiliated entity (collectively, "WCE") is subject to dismissal without reimbursement or recourse. I hereby grant my permission for photographs, DVD, or video of my child that are taken during his/her participation in WCE, in any format including electronic media, to be used by the program for any purpose, including advertising for WCE/EWE. The participant and his/her parents hereby waive and forever relinquish any rights to such images, waive the right to prior notice of such use, and acknowledge the right for WCE to use such images without compensation. I am aware that the activities (including camps, showcases, events, games and trips) my child is engaging in (as well as any necessary medical treatment provided as a result of said activity) may involve hazards and risks of significant injury or death as one of the results associated with the activity. I have considered these risks and I still wish my child to participate in said activities despite the gravity of said risks. Furthermore, I agree not to bring any legal action against WCE, WCE' staff, WCE' sponsors or person making the medical decisions as a result of any property damage, injury, or death that my child sustains while engaging in the WCE sponsored event (or any subsequent medical treatment provided thereafter) or injuries/death suffered in the course of his/her participation. I hereby authorize any adult agent of WCE, into whose care the above mentioned minor child has been entrusted, to obtain proper medical care from a licensed medical or dental doctor or facility. The medical/dental care is to include, but not be limited to, any x-ray,examination, anesthetic, medical or surgical diagnosis or treatment and hospital care to be rendered to said minor under the general or special supervision and upon the advice of a licensed medical doctor or dentist. It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required, but is given to provide authority and power on the part of said adult person to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician or dentist in the exercise of his best judgment may deem advisable. This authorization shall include transportation to receive the medical or dental care. This authorization is given pursuant to the provisions of Section 25.8 of the Civil Code of California. This authorization shall remain effective until my child completes his/her activities in this program unless sooner revoked in writing. In the event of injury to my child, I agree that I and my healthcare insurer shall be financially responsible for any medical treatment required by my child as a result of any injury or illness suffered during his/her participation in any WCE related activities. My child's insurance coverage information is as follows (if your child does not have medical insurance, please note)
Yes, I agree to the above with my electronic signature
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