Watch DOGS Cowboy Ranch Retreat
Waiver and Release Form
Authorization of Treatment - I hereby give my permission to the medical personnel selected by the group to order treatment and necessary transportation for my child. In the event I cannot be reached in an emergency, I hereby give my permission to the physician to secure and administer treatment, including authorization for my child(ren) named here. *
Required
Release Statement - I acknowledge that participation in athletics carries with it a risk of physical injury. I hereby affirm that my child is in good health and physically capable of performing the required activities of event. I agree that its agents and employees shall not be liable to me or my child for any injury or damage, howsoever caused, resulting directly or indirectly form my child’s participation in the event at any time preceding, during or after camp is in session. I hereby discharge the group, its agents and employees from all actions, claims, and demands I or my child may have for any such injury or damage. *
Required
Photo Release - I hereby consent to the taking of photographs, movies, Internet use, and video tapes, of my child at event. By agreeing, you, the parent/guardian, give permission for your child’s picture to be on Watch DOGS website and possibly be used in other means of marketing ( promotional video, newspaper advertisements, etc.). I also grant the right to edit, use , and re-use said products for any and all educational, public service, or not for profit purposes selected by the group and release any and all rights, title, and interest we or the child may have in said products. Photocopies and facsimiles of this Release and consent shall have the same legal effect as the original. *
Required
Travel - I give my permission for my child to travel and to trip destination. *
Required
Parent/Guardian Name *
Your answer
Parent/Guardian Address
City, State, and Zip
Your answer
Parent phone number *
Mobile is preferred
Your answer
Parent Email Address *
Your answer
Known physical problems or allergies
Your answer
Known medications and Dosage
Your answer
Child Physician Group or Business Name
Example, Pediatric Physicians
Your answer
Child Physician name
Your answer
Child Physician phone
Your answer
Insurance Company
Your answer
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