Thundercat Sports Camps Information/Waiver Form Player's full name_____________________________________________ Age____ Date of Birth ____/____/_____ Parent/Guardian full name______________________________________ Full Address ______________________________________________________________________________________________________ Tel. # Home ____________________________ Work __________________________ Cell/Other _________________________________ E-mail:________________________________________________________ Person to notify in emergency ___________________________________________________ Tel # ________________________________ Player's health insurance company_______________________________ Player's health insurance policy # ___________________________ Player's doctor's name_________________________________________ Player's doctor Tel.______________________________________ Medical Concerns/Allergies of player (if none please write none, if yes please describe and see the camp director) _____________________ _________________________________________________________________________________________________________________ WAIVER / INDEMNIFICATION Parent(s) or legal guardian must sign below before player is accepted to participate in the Thundercat Sports camps: As parent/legal guardian of the child named herein, I hereby represent that the child has been examined by a pediatrician and is physically fit to participate in the Thundercat Sports camps. I understand there are inherent risks to participating in this athletic program. I hereby accept responsibility for and agree to pay any and all costs of medical treatment resulting from any injury suffered by my child as a result of his/her participation at Thundercat Sports camps. I further agree to indemnify and hold harmless Newton Community Education, as well as Thundercat Sports, and its agents, employees and/or representatives, from any and all liability, damage, or expense arising out of my child’s participation at Thundercat Sports camps. In the event that I cannot be reached in an emergency, I hereby give permission for a qualified Thundercat Sports. staff member, an emergency medical technician, a physician or staff member at a hospital, or any other qualified individual to administer care and provide any medical treatment deemed necessary for my child. Signature of parent(s) or legal guardian: _______________________________________________________________________ Date: ________________.
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