Release and Medical Authorization

RELEASE AND MEDICAL AUTHORIZATION

Greenway High School

3930 W. Greenway Rd. 85053

Participants Name______

Father/Guardian Name______Home Phone______Mobile Phone______

Employer______Work Phone______Fax Number______

Mother/Guardian Name______Home Phone______Mobile Phone______

Employer______Work Phone______Fax Number______

Insurance Provider: ______Policy Number: ______

Please use the following space to explain any special instructions/circumstances the staff should be aware of regarding the health of your child: ______

______

Greenway 8th Grade Football Camp

Instructors will take every measure to ensure proper instruction, supervision and adherence to all safety rules are enforced. Due to the nature of this camp being dynamic movements, some contact and cardio-respiratory training, although infrequent, injuries due occur.

RELEASE OF LIABILITY

In Consideration of Greenway High School at granting the above named participant permission to participate in camp, I hereby assume all risks of his/her personal injury that may result from any physical activity. As Parent/Guardian, I do indemnify defend, and hold harmless, GreenwayHigh School, Glendale Union High School District #205, and its officers, employees, agents, instructors, and all participants in the camp program from and against all liability, including claims and suits at law or in the equity, for injury, fatal or otherwise, which may results from any negligence and/or the student taking part in Football Camp activities.

CONSENT FOR TREATMENT AND/OR FIRST AID

In the unlikely event of injury or illness, I hearby give my consent for medical treatment and permission to a nurse/certified athletic trainer to supervise on-site first aid for minor injuries, and to a licensed physician to hospitalize and secure proper treatment (or other reasonable treatment and necessary procedures) for the student. EVERY ATTEMPT WILL BE MADE TO CONTACT YOU, THE PARENT/GUARDIAN, PRIOR TO ANY MEDICAL ATTENTION BEYOND FIRST AID, IS GIVEN.

Parent/Guardian Signature

(STUDENT IF 18 OR OLDER) …………………………………………………………………………… DATE: ……/… /…….

PLEASE BRING THIS FORM TO CAMP. YOU WILL NOT BE ABLE TO PARTICIPATE IN CAMP ACTIVITIES UNTIL THIS FORM IS COMPLETE