Emergency Contact Information printable pdf download

Emergency Contact Information

Runner’s Name: ________________________________________

Phone Number:______________ Cell Phone (If available): _____________

Parents Names: _________________________________________

Allergies or Medical Conditions:

_____________________________________________________________

Other contact if Parents cannot be reached

Name _____________________________________

Phone ____________________________________

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Medical Release Form

(Medical Consent and Release)

-- Please read carefully and sign below --

I certify that my child is in good physical health and has my permission to

participate in all the activities associated with the Leslie Schools Cross

Country Camp.

I authorize the directors of the camp to act in their best judgment in any

emergency requiring medical attention. I authorize all medical, surgical,

diagnostic and hospital procedures as may be performed or prescribed by a

treating physician for my child if I am unable to be reached in an emergency.

I understand that neither Leslie Schools, the camp directors, nor anyone else

connected with the camp assumes any responsibility for accidents (medical

or dental) or other injuries incurred as a result of attendance at this camp.

I will furnish insurance for my child.

__________________________________

_________________

Parent/Legal Guardian

Date

Emergency Contact Information