St. Ignatius Basketball Camp Liability Waiver Form printable pdf download

St. Ignatius Basketball Camp Liability Waiver Form

St. Ignatius Basketball Camp

Liability Waiver Form

Student-Athlete’s Name_____________________________________________

Address _________________________________________________________

City ________________________________________ Zip _________________

Parent email address _______________________________________________

Parent/Guardian’s Name ____________________________________________

Parent/Guardian’s Phone ___________________________________________

Emergency Contact’s Name _________________________________________

Emergency Phone _________________________________________________

Does the Player Have Asthma? (Circle One)

Yes

In case of emergency, do you want the clinic directors to seek medical care?

(Circle One) Yes No

Physician ___________________________ Phone _______________________

LIABILITY WAIVER: I am aware that participation in the St. Ignatius Basketball

Camp has some inherent risks and injury can occur. On rare occasions these

injuries can be serious. In consideration of my child being allowed to participate

in the St. Ignatius Basketball Camp, I, the parent/guardian, assume the risk of all

injury and agree not to sue St. Ignatius College Preparatory, the camp directors,

coaches, assistant coaches, agents, or volunteers for any and all injuries caused

by or resulting from participating in the St. Ignatius Basketball Camp. By signing

this waiver, I also authorize the use of pictures of the above-named participant to

be posted on the St. Ignatius College Preparatory web site or advertising media

published by St. Ignatius College Preparatory.

Parent/Guardian Signature _________________________________________

Date ______________________________________

ST. IGNATIUS ATHLETICS

Saint Ignatius College Preparatory - 2001-37th Avenue - San Francisco, California 94116

Phone (415) 731-7500 - Fax (415) 661-0150 -

St. Ignatius Basketball Camp Liability Waiver Form