Print & Complete Medical Release Form


Please complete the following Medical Waiver/Release. It must be filled out completely, printed, and signed. The Medical Waiver/Release is also available to download in Microsoft Word format or Adobe Acrobat format.

Requirements:

All campers must return the medical release wavier with medical insurance information and signature of a parent or guardian no later then check-in on the first day of camp. Campers will not be able to participate in any camp activities until all the necessary paper work has been completed and proof of medical insurance has been provided.

 

Kevin Dresser Wrestling Camps – VA Tech Clinic

Release / Waiver of Claims

I/We the parent(s)/guardian(s) of the below-named athlete or coach, who is a candidate to attend the 2008 KEVIN DRESSER WRESTLING CAMPS, do hereby give my/our approval to my/his/her participation in all of the activities of the KEVIN DRESSER WRESTLING CAMPS. I/We assume all risks and hazards incidental to the conduct of the activities and transportation to and from the associated activities. I/We do hereby release, absolve, indemnify, and hold harmless the KEVIN DRESSER WRESTLING CAMPS, as well as the organizers, sponsors, volunteers, coaches, supervisors, and school officials. In case of injury to my/our child, I/we hereby waive all claims against the organizers and of any of the supervisors/coaches/assistants appointed by them. I/We likewise release from responsibility any person(s) transporting my/our child to and from the activities of the KEVIN DRESSER WRESTLING CAMPS. To date, I/we have no knowledge of any medical problems or conditions that might endanger or preclude the partcipant from participating in this activity. Any other medical conditions, which I agree are not serious enough to preclude my/our child’s participation in the activities of the KEVIN DRESSER WRESTLING CAMPS, are noted below. If the participant is currently under a doctor’s care, I/we will consult the participant’s physician prior to his/her participation.

In signing this Release / Waiver (below) I/We acknowledge that I/We have read and agree to comply with the policies and rules of the camp. We further acknowledge that failure to follow these rules and policies may result in dismissal from the clinic without refund.

Do you have any medical Insurance?
Yes No
Policy Holder's Name:
Name of Insurance Company:
Insurance Company Address :
Insurance Company Policy Number:
Does your child have any existing Medical Conditions?
Yes No
If yes, please explain:
Athlete's Printed Name:
Athlete's Signature: (Print to Sign)
Parent's/Guardian's Printed Name:
Parent's/Gaurdian's Signature: (Print to Sign)
Date: