Insurance And Liability Waiver Consent Form

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INSURANCE AND LIABILITY WAIVER & CONSENT FORM
I understand that I am required to have accidental medical coverage for the child listed on this waiv-
er, and I verify that the information provided on this form is accurate and true.
I understand and agree that if I do not have accidental medical coverage for the child listed on this
waiver, I will be financially responsible for all charges and fees incurred in the rendering of said treat-
ment. In case of an injury, I authorize the staff of Utah State University to render first aid.
I understand that at the discretion of the camp supervisor and staff my child may be dismissed from
the camps without refund for inappropriate behavior.
I understand that at the conclusion of the scheduled camp time the program and staff are no longer
responsible for my child.
I give permission to use, reprint and produce any photographs or videos taken of me or my child and
written materials supplied by me or my child in the form of evaluation during the youth sports pro-
gram.
I herby authorize the Aggie Softball Camp staff to act for me in case of an emergency and waive
and release Aggie Softball Camp from any and all liability for any and all injuries and illness occurred
while at camp:
________________________________
Parent/Guardian Signature
________________________________
________________________________
Insurance Company
Policy Number
________________________________
________________________________
Emergency Contact Phone Number
Emergency Contact

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