Text Box: Please return signed Waiver and Release Form with Payment. In consideration of the acceptance of this application for the Lion Team Football Camp, I am aware of and understand the potential dangers of participating in contact football activities. I understand that catastrophic injury or accident can occur through participation in football. I freely and voluntarily assume all such risks and consent to my son’s participation in the Lion Team Football Camp. I, intending to be legally bound hereby for myself, my heirs, executors and administrators, waive and release any and all rights and claims which I may have against the Auburn School District, Auburn Mountainview High School, Auburn Mountainview Football Booster Club and its representatives, employees, respective agents, and/or assignees, for all damages which may be sustained and suffered in connection with my or my son’s association with any portion of this camp or related activities, and which may arise out of my or my son’s traveling to or returning from camp. I know of no medical or physical problems that may affect my son’s ability to participate safely in this camp. I hereby give my consent to the camp staff to attend to any health problems or injury my son may incur while attending this camp. Further, I give my consent for medical treatment and permission to the Attending physician to hospitalize, secure proper treatment, and order injections, anesthesia, or surgery. I accept full responsibility for the cost of any medical or other charges in connection with my son’s attendance at camp . BY SINGING THIS FORM, I ACKNOWLEDGE THAT I HAVE READ THIS WAIVER AND RELEASE FORM AND UNDERSTAND ALL OF ITS TERMS. I SIGN THIS RELEASE VOLUNTARILY AND WITH FULL KNOWLEDGE OF ITS SIGNIFICANCE. Signature of parent or guardian__________________________________________ Date___________

Preexisting Conditions

HAS THE CAMP PARTICIPANT HAD, OR CURRENTLY HAVE, ANY OF THE FOLLOWING:

Concussions        Y   N            Allergies     Y    N

Joint/Bone Injury  Y   N            Asthma       Y    N

Heart Condition  Y   N            Surgery       Y    N

Other medical conditions not specified above  Y      N

If yes, please explain:  __________________________________________

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Insurance Information (fill in each line)

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Primary Medical Insurance Company

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Policyholder’s Name

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Group Policy #

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Policy #

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Claims Phone #

Check or Money Order  for $200.00

Make check payable to: Auburn Mountainview Football Booster Club

No Camper will be admitted to camp unless the form is completed, signed, and returned to Coach Price by June 13, 2008.

QUESTIONS?  PLEASE CALL 253-804-4539 EXT 4030
 

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Participant Name (Print)

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Home Address

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City                                                                  Zip Code

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Home Phone

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Preferred Roommate

 

Parent/Emergency Contact Information

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Parent/Guardian Name (Print)

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Parent/Guardian Address

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City                                                                   Zip Code

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Parent Daytime Phone                        Parent Evening Phone

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Emergency Contact Name

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Emergency Contact Relationship

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Emergency Contact Daytime Phone

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Emergency Contact Evening Phone