Riverbend Football and Cheer Camp * 2014 Registration Form

RIVERBEND FOOTBALL AND CHEER CAMP * 2014 REGISTRATION FORM

**EACH PARTICIPANT NEEDS A COMPLETED FORM**

**BE SURE TO COMPLETE BOTH SIDES**

**CHECKS SHOULD BE MADE PAYABLE TO RIVERBEND HIGH SCHOOL**

CAMP:(please select) FOOTBALL

CAMPER’S NAME:______AGE:______

EXPERIENCE:______

SIBLING PARTICIPANT?______

ADDRESS:______

CITY, STATE, ZIP:______

EMAIL ADDRESS:______

PHONE:______

SCHOOL:______GRADE:______

EMERGENCY NAME:______

EMERGENCY #:______

FOOD ALLERGIES?______

PARENT/GUARDIAN NAME:______

PERSONS AUTHORIZED TO PICK UP:______

ADDITIONAL INFORMATION REGARDING CHILD THAT MAY BE BENEFICAL

TO THE COACHING STAFF:______

______

PARTICIPANT NAME:______

Insurance Waiver Form

In consideration of my application being accepted, I, intending to be legally bound, for myself, my executors and administrators, waive and release and forever discharge any and all rights and claims for damages which I may have hereafter accrued to me Christine O’Leary and Joseph DeMarco or the Spotsylvania County School Board. I waive all claims against Spotsylvania County employees and administrators or its respective officers, agents, representatives, successors, and/or assigned camp staff, for any and all damages which may be sustained or suffered by me in connection with my association with or participation in and/or rising out of my travel to Riverbend High School Football and Cheerleading Camp to participate in on the campus of Riverbend High School.

I, the parent/guardian of______, do hereby agree to the above waiver and release.

Parent/Guardian Signature______

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Camper’s Name______

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examinations and immunizations for the above-named camper. In the event of a serious illness, the need for major surgery or significant accidental injury, I understand that an attempt will be made to contact me in the most expeditious way possible. If said physician is not available to communicate with me, my signature authorizes the treatment necessary for the best interest on the above named child.

In the event that an emergency arises during a camp session, an effort will be made to contact the parents or guardians as soon as possible. Permission is also granted to the camp staff rescue squad to provide the needed medical treatment to the camper prior to their admission to any medical facilities.

Name of Family Physician:______Phone:______

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PHOTO RELEASE FORM

I hereby grant Riverbend High School permission to use the likeness of my child, ______, in any and all of its publications, including websites. (We will not publish your child’s first or last name, address, phone numbers, or other information protected by federal regulations.) I understand that any and all of these likenesses will become the property of Riverbend High School. I hereby authorize Riverbend High School to exhibit or publish any likenesses for the purpose of publicizing any and all Riverbend Football and Cheer Camp activities or any other lawful purpose.

Parent/Guardian Signature:______Date:______