Church at Dickinson Softball Camp Registration Form

Confirmation
Emergency Treatment Parental Consent
I give my express and full permission to have my child treated by any qualified medical personnel, in case of any circumstance that such attendance be so required to do the following:
Name of Doctor

First NameLast Name
Medical Care Facility
Waiver

I am aware that any physical sport activity may cause accidental injury or harm among the athletes, and I assume any and all possible risk that may cause injury, illness, or death arising to such activity. I agree to waive my right to pursue any claim against Church at Dickinson for this event.
Signature of Parent / Guardian
Should be Empty:

Emergency Contact Information