CADET HOOPS CAMP

WAIVER AND REGISTRATION

STATEMENT OF APPROVAL, AUTHORIZATION, AND RELEASE

Participant______Grade (Fall 2015)______

Parent or Guardian’s Name______

Day Time Phone Number______

Address______Telephone______

Amount Paid $ ______(Checks payable to Connally Basketball)

T-shirt size: ______

The undersigned parents/guardian consent to ______(Participant) participating in the Cadet Hoops Camp program, sponsored by the Connally Athletic Department with the approval of Connally I.S.D. We the undersigned, including the participant, acknowledge and agree as follows:

1.  We understand that the program will involve exercise and conditioning activities, and that there is an element of risk that the participant may be injured while participating in such activities, even under normal circumstances. We assume this risk and agree to indemnify the program and its instructors harmless in regard to all such injuries.

2.  We authorize the program’s instructor’s and agents to provide medical aid and treatment to the participant at any time during the program for the purpose of attempting to relieve any injury discomfort arising from or in any way connected with participating in the program, and we hereby release the program, instructors, and Connally ISD and agents from any and all claims or causes of action resulting from or arising out of any treatment authorized in this paragraph.

3.  We authorize the program’s instructors and agents to consent to medical treatment for any injury to participant arising from or in any way connected with participating in the program in the event the undersigned person(s) who has/have the power to consent to medical treatment cannot be contacted.

4.  Each of the undersigned represents that his/her relationship to the participant is correctly stated above his/her signature, and if any of the undersigned person(s) (other than participant) is not a parent of the participant, that a true and correct copy of official documentation stating his/her relationship is attached hereto.

SIGNED THIS ______DAY OF ______, 2014

______

Father of participant Mother of participant

______

Guardian of participant

Emergency Contact(s)

Name______Phone______