High Power Sports Camp

Relationship to Camper

Date of Birth

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Medical and Liability Relase

By checking this box I agree that as legal guardian I realize no activity is without the possibility of unforeseen hazards which could result in injury or worse. As a parent or guardian, I am aware of my responsibility to instruct my child/ward of the importance of conduct which will insure safety for all participants, and in doing so I assume full responsibility for my child/ward. I further agree to absolve and hold harmless the sponsoring organizations and their representatives for damage, loss, abuse, death, or injuries to my child/ward.

By checking this box I give my child permission to participate in this activity, and give my permission to the leaders of this function to authorize any treatment necessary for any injury. I also certify that I am the legal guardian of this child and can sign for them in a legal capacity.

List your child's recent injuries, chronic conditions, or anything they take medications for.

Choose Sport Option *

Soccer

Cheer

Emergency Contact

Gender

Parent/Guardian: Electronic Signature and Date

List any drug, food, or environmental allergies your child has:

High Power Sports Camp Registration

Physician's Name and Phone Number

Age

Emergency contact phone

Phone

Emergency Contact

Camper's Name *

Address

Please fill out this registration form for each child you wish to register :)

Parent/Guardian Name

T-shirt Size

Photography and Publicity Release

If this box is marked then I DO NOT give permission for any of the sponsoring organizations to use photography that includes my child/ward. If this is blank, then I give permission to all sponsoring organizations to use my child’s likeness, image, voice, and/or appearance as such may be embodied in any media including but not limited to pictures, photos, video recordings, audio tapes, digital images.