2008 Brandywine Volleyball Club Camp Medical Release Form

This form must be completed - legibly - and signed in all areas by both the player and his or her parent or legal guardian. 

By signing this form the participant affirms having read it.

Last Name First Birthdate
Age Sex  
Parent or Guardian Emergency Contact:
Name Name
Address Home Phone
City                      State            Zip Work Phone
Home Phone Insurance Co.
Work Phone Group/Policy #
High School of student attending camp: Does policy cover sports related accidents?         
Camp Session:

YES     OR       NO
To whom it may concern: Participant,   (  _____________________________  ) has my permission to participate in training, camp, competition, events and activities sponsored by the Brandywine Volleyball Club. I approve of the leaders who will be in charge of this program. I recognize that the leaders are serving to the best of their ability. I certify that the participant has full medical insurance with the company listed above.   I also certify to the best of my knowledge that the participant named hereon is physically fit to engage in the activities described above.

I am fully aware that the sports programs may present a risk of injury. I am fully aware and appreciate the risks and damages that might occur as a result of my child's participation in the program. Nonetheless, I, on my own behalf and that of my child, and our heirs, administrators and executors, do hereby release, indemnify and agree to hold harmless Brandywine Volleyball Club and all persons or entities associated with Brandywine Volleyball Club and Wilmington Friends School from any responsibility or liability for any and all claims, demands, damages, costs, causes of action, and expenses (including without limitation, seasonable attorney fees) arising out of or resulting from my child's participation in or involvement with the sports programs, including without limitation any personal injury, disability or property damages incurred or sustained by me or my child during or as a result of the sports programs.

I hereby verify that I fully understand and accept the preceding conditions for permitting my child to participate in this sports program.

Signed _________________________________________                          Date: _______________               Relationship:  
To the Camp Leaders: If during the course of my daughter's (/son's) activities in volleyball should she/he become ill or sustain an injury, I hereby authorize you to obtain emergency medical/dental care.  Signed ________________________________ ( Parent or Guardian )    Date: _______________
I do not authorize emergency medical/dental care for my daughter/son.  Signed ____________________________ ( Parent or Guardian )Date: