AUTHORIZATION TO CONSENT TO MEDICAL TREATMENTAND RELEASE OF LIABILITY FORM & PHYSICAL UPLOAD

I (We)     Parent Names    are the parent(s)/legal guardian(s), with legal custody of   Child's Name  (child’s name) birth date   Date   who is   Age(age) and resides with us at Street Address   Address Line 2   City   State   Zip (full address) and who attends   School(name of school) give permission for our child to attend the Calvin Johnson Jr. Foundation, Inc. Football Camp. We also give permission for a licensed physician, nurse, trainer or emergency treatment center selected by the camp officials/representative to administer the necessary attention and aid IMMEDIATELY to our child should he/she become injured or sick during the Calvin Johnson Jr. Foundation, Inc. Football Camp and to do so without having to wait until we are contacted. We consent to any X-rays, examination, anesthetic, medical or surgical diagnosis treatment and hospital care deemed necessary. We understand the Calvin Johnson Jr. Foundation, Inc. Football Camp staff members or representatives will endeavor to reach us should the nature of the injury or illness warrants it. However, we will not hold any of the camp personnel responsible if efforts to contact me/we are unsuccessful. I also will not hold staff/representative of the Calvin Johnson Jr. Foundation, Inc. Football Camp liable of any injury cause while my child is participating with the camp. 

During the time of the camp we can be reached at:
 FATHER’S CELL PHONE:   Area Code   Phone Number              
MOTHER’S CELL PHONE:    Area Code   Phone Number   
EMERGENCY CONTACT NAME:   First Name   Last Name   
EMERGENCY CONTACT NUMBER:   Area Code   Phone Number   

Child's Medical Insurance Company:      
Policy Number:   Type a label