Summer Camp Registration

Parent/Guardian Information

Emergency Information

Informed Consent and Acknowledgement

I understand that there are risks associated with playing all sports and field related  activities. In consideration for the privilege to use the facility and/or attend the  camp/clinic/training, my signature indicates that I assume the responsibility of any injuries that myself or my children may sustain while participating in any activity at MindTap Athletics. This includes any injuries that myself or my children may sustain prior to, and after participating at MindTap Athletics’ events. I ensure that I am or my child is physically and mentally able to participate in physical activities and have been examined by a licensed medical physician within one (1) year prior to attending this clinic/camp. 
I understand that MindTap Athletic is not responsible for myself or my child’s personal items that may have gone missing/damaged prior to, during and after participating at MindTap Athletics events. Alternatively, I understand that I’m liable for myself or my child damaging/losing equipment during, and after sessions. 
I INDEMNIFY, HOLD HARMLESS, AND PROMISE NOT TO SUE the entities or persons mentioned in this paragraph from any and all liabilities or claims made as a result of participation at MindTap Athletics, whether caused by negligence or otherwise.
I give permission for camp trainers and coaches or contracted health care to start  preliminary treatment and arrange transportation for me or my child to a local Emergency Room in the event that I or my child become(s) ill or injured.
By signing this Waiver and Liability Agreement, I acknowledge that I HAVE READ  AND FULLY UNDERSTAND AND AGREE TO ALL OF ITS TERMS AND  CONDITIONS. I further state that I have executed this waiver and liability voluntarily and with full knowledge of its significance to be binding on myself, my heirs, executors and administrators.

 

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  {Organization} . 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.

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.