Blacksburg Bruins Youth Football Camp

Blacksburg Bruins Youth Football Camp

I, ___________________________ do hereby grant permission for my son/daughter, ___________________________ to participate in the youth football camp at Blacksburg High School. By signing, I am releasing Blacksburg High School, the athletic department, any and all of the coaching staff, trainers, and assistants from any and all liabilities in the event that an injury or illness does occur.

I, the parent/guardian certify that, to the best of my knowledge, the participant (stated above) is physically and mentally capable of participating in activities to include, but not limited to, exercising, running, jumping, throwing, catching and kicking a football.

In the event of an injury, I hereby grant permission for the training staff at Blacksburg High School to administer first aid. If the injury is considered life threatening, and I am not present and/or cannot be reached by phone, I grant permission for the training staff to summon the Blacksburg Rescue Squad and have them transport my son or daughter to the nearest medical facility and for them to begin whatever treatment deemed necessary.

Information:

Medications:____________________________________________

Allergies:__________________________________________________

Any physical limitations: (i.e. – Asthma)___________________________________
____________________________________________________________________
____________________________________________________________________
____________________________________________________________________

Phone Numbers: Cell _________________ Home ____________________

Office ____________________

Signature : Parent/Guardian _________________________ Date: _______