Liability Waiver Form Jahe Basketball Camps Child Children (Page 2 of 2) in pdf

Liability Waiver Form Jahe Basketball Camps Child Children Page 2

Jackson Area Home Educators

PO Box 6380, Jackson, MI 49204

(517) 783‐9378

JAHE Sports Club Player Identification and Medical Card

Every JAHE Sports participant is required to complete the following, including parent / guardian signatures.

Players will not be permitted to participate in practices or games until this form has been completed and turned in.

Sports (Circle): Boys Basketball Girls Basketball Girls Volleyball

ID/MEDICAL cards will be kept on hand at all practices and games. We hope that they will never be necessary.

However, in the event of a medical emergency, we want to be sure that we can provide the best care possible to

players. Having this ID/MEDICAL card on hand will insure that any necessary treatment and care can be rendered

immediately in the event that we are not able to contact a parent.

PLAYER NAME: ____________________________ Birthday: __________ Grade: ______ Sex: M / F

Street: __________________________, City: ____________________, State: _____, Zip: __________

Father: _________________________________ Mother: ________________________________

Home Phone: _______________ Cell Phone: _______________ Email: _______________________________

Other Emergency Contact?: __________________________________ Phone: ____________________

Family Physician: ________________________ Insurance (optional): ___________________________

Medical Conditions, allergies or regular medications:

____________________________________________________________________________________

_____________________________________________________________________________________

In the event of an emergency, I hereby authorize that medical services be given to my child as

deemed necessary by the attending physician.

Parent / Guardian Signature: ___________________________________ Date: __________

Page 10 of 10

Liability Waiver Form Jahe Basketball Camps Child Children Page 2