2014 North Valley Sports Camps
Registration and Release Form

Please fill out the following form for each camp the athlete plans to attend. 
You must submit your payment at camp check-in.

Camp Attending:
Athlete Information
Athlete's Last Name:
Athlete's First Name:
Street Address:
City:
State:
Zip Code: (5 digits)
Phone Number:
School:
Grade in Fall:
Athlete's Weight:
(for Wrestling Camp only)


Parent / Guardian Emergency
Contact Information

Parent Last Name:
Parent First Name:
EMAIL::
Cell Phone Number:
Home Phone Number:
Work Phone Number:
Medical Information
Restrictions on Participation:
Medical Insurance Company:   
Group Number:
I.D. Number:
Insurance Phone Number:

Authorization to Consent to Treatment of a Minor

I/We, the undersigned parent(s) of the aforementioned child, a minor, do hereby give permission for Trainers and Coaches of North Valley Sports Camps to seek emergency care for my/our child at a local medical facility if I/We cannot be reached in the event of illness or injury.  It is understood that this authorization is given in advance of any specific diagnosis or treatment being required, and I/We will be contacted in the event of illness or injury as soon as possible.  This authorization shall remain effective until camp ends unless sooner revoked.

 

Release of Liability

I/We, the parent/guardian of  the aforementioned child, hereby give permission for my/our child to participate in the North Valley Sports Camp.  I/We understand there are obvious known risks/dangers inherent in the participation of this program, including but not limited to injuries sustained through a fall or loss of personal property, and I/We voluntarily agree to assume such risks. 

In consideration of NVSC permitting my child’s participation in the camp, based on my reputation that my/our child is in proper physical health and condition to participate, I agree: 1) to assume all risk of injury to my child and all risk of damage or loss of my child’s property arising from my child’s participation in the camp, and 2) to release and forever discharge NVSC, its officers, agents, host sites, employees and coaches, from any and all claims or liability for any injury including death, and for any property damage or loss which may be suffered by me or my child arising out of any connection with my child’s participation in the camp.

I have carefully read this agreement and fully understand its contents.  I am aware that this is a release of liability and a contract between the camp and myself, on behalf of my/our child, and I/We sign of my own free will.


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