Waiver | im-mike-brown

Football Camp Liability Waiver

Participant First Name

Participant Last Name

Parent/Guardian Full Name

Please specify anything we should know about

Initials

I declare that the info I’ve provided is accurate & complete

I hereby acknowledge this release from liability for accidental injury or illness which I may incur as a result of participating in any physical activity. I hereby assume all risks connected therewith and consent to participate in this program. I agree to disclose my physical limitations, disabilities, ailments, or impairments which may affect my ability to participate in this program with the medical staff prior to participating.

Parent/Guardian Signature

Emergency Contact Name

Emergency Contact Phone Number

I hereby give my consent to POOR Athletics Foundation Inc. to use my photographs from this event

THANKS FOR SUBMITTING!