Participation Waiver
This release and waiver is executed on this ______day of ______2016.
I, (parent or guardian’s full name) ______, hereby state that my child, (child’s full name) ______, is ______years of age, is in good health and has my permission to participate in all Tigers Basketball Camp activities. I authorize the staff of the camp to provide emergency first aid in the event of sickness or injury. I also give my permission for the coach/sponsor to sign for me in the event that emergency treatment, hospitalization, and/or surgery is required. I understand I am financially responsible for any medical bills incurred by my child while at the 2016 Tigers Basketball Camp.
By signing this release, I for myself, my child, my heirs and executors hereby forever release the camp, camp sponsor, camp workers, camp volunteers, Paul Quinn College, its employees, officers and agents associated with the event or activity, or officials with participating organizations from any and all liability and any manner of actions, suits, damages, claims, demands, and injury (including death), and actions whatsoever in a manner arising from my child’s participation in this camp or medical treatment rendered as a result of personal injury arising from my child’s participation in this camp.
I have full knowledge of all risks involved in this camp and my child is physically fit to participate in this camp. I grant permission for photos and other records of this event to be used to further the cause. If, however, as a result of my child’s participation in the camp. If my child requires medical attention, I hereby give consent to authorize emergency medical personnel to provide such medical care as deemed necessary. I also understand that as a participant in this camp, I agree to ensure my child conforms and complies with all laws of the United States, the State of Texas and all ordinances of the city of Dallas, Texas and all the regulations of the Paul Quinn College Athletic Department.
Please list any medical conditions the camp volunteers should be aware of during camp below:
Our Health Insurance Provider: ______Policy #: ______
Emergency Contact: ______Telephone Number: ______
I, the undersigned, understand all of the above:
Signature of Parent or Guardian Printed Name Date