LOJF Registration Form

Camp Attending

Machias July 13-17 Prescott St Field, Machias (next to Hannafords)

Athlete Information

(include photo of athlete below if possible).

Take Photo

Athlete's Name *

First Name Last Name

Birth Date *

Month Day Year

Grade *

Address *

Street Address

Street Address Line 2

City State / Province

Postal / Zip Code Country

Parent/Guardian Information

Name *

First Name Last Name

Home Number *

Area Code Phone Number

Cell Number *

Area Code Phone Number

E-mail *

E-mail

example@example.com

Emergency Information

Emergency Contact's Name *

First Name Last Name

Relationship *

Phone Number *

Area Code Phone Number

Alt. Phone Number

Area Code Phone Number

Does the athlete have any allergies, chronic illness, or medical conditions? If yes, please describe. *

Is the athlete prescribed an inhaler? If yes, please explain any instructions. *

Informed Consent and Acknowledgement

I hereby give my approval for my child’s participation in any and all activities prepared by Lion of Judah football during the selected camp. In exchange for the acceptance of said child’s candidacy by Lion of Judah Football, I assume all risk and hazards incidental to the conduct of the activities, and release, absolve and hold harmless Lion of Judah Football. and all its respective officers, agents, and representatives from any and all liability for injuries to said child arising out of traveling to, participating in, or returning from selected camp sessions.

In case of injury to said child, I hereby waive all claims against Lion of Judah Football. including all coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in all sports activities, including basketball. Some of these injuries include, but are not limited to, the risk of fractures, paralysis, or death.

Medical Release and Authorization

As Parent and/or Guardian of the named athlete, I hereby authorize the diagnosis and treatment by a qualified and licensed medical professional, of the minor child, in the event of a medical emergency, which in the opinion of the attending medical professional, requires immediate attention to prevent further endangerment of the minor’s life, physical disfigurement, physical impairment, or other undue pain, suffering or discomfort, if delayed.

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the named athlete. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that every attempt will be made by the attending physician to contact me in the most expeditious way possible. This authorization is granted only after a reasonable effort has been made to reach me.

Permission is also granted to the Lion of Judah Football. and its affiliates including Directors, Coaches, and Team Parents to provide the needed emergency treatment prior to the child’s admission to the medical facility.

Release authorized on the dates and/or duration of the registered season.

This release is authorized and executed of my own free will, with the sole purpose of authorizing medical treatment under emergency circumstances, for the protection of life and limb of the named minor child, in my absence.

Liability

Participate at your own risk. By signing below, I agree and understand that my son will participate in the Lion of Judah Football program at their own risk and that the coaches and helpers/supporters assume no fault for the accidental injury of my child whether resulting in death or disability and the cost of all medical treatment resulting from any accidental injury will be paid by me. He may also be transported to other locations by private vehicle.

Belief in the Bible

I understand that the Lion of Judah Football program is a Faith based sports program and that the coaches and helpers believe that the Bible and its original translations contain the infallible and inerrant Word of God and that the only way for the soul of a man or woman to be saved from eternal torment is belief in Jesus Christ our Lord and Savior.

Photos of the Participant

I will allow pictures of my child to be taken, and I agree that any photo reproduction of the image of my child while participating in the Lion of Judah program is the exclusive property of the Lion of Judah Football Program.

Confirmation

BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.

Signature *

Clear

2020 Camp Registration