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2011 CASCADE FOOTBALL TEAM CAMP
At the foot of Beautiful Mt. Shasta - in McCloud, California
Hosted by: Cascade Team Camp, A Non-Profit Corporation
For questions or assistance, please call Matt Hunsaker @ 530-275-7075 ext 250

CAMP FEE: $155 per Athlete

ATHLETE INFORMATION

Name (print):  ______________________________________________________

Address:___________________________________________________________

City_______________________________  State _______ Zip Code____________

Home Phone_______________ Cell _____________ Emergency #_____________

Grade:  Soph  Junior  Senior       High School Name __________________________

DOB ____/____/____   Height_____  Weight______  T-Shirt/Jersey Size________

MEDICAL INFORMATION

Informed Consent, Waiver & Release of Liability and Medical Care & Treatment Authorization

1. I agree that the parent(s) or legal guardian(s) will instruct the minor participant that prior to participating, he should inspect the facilities and equipment to be used, and if the participant believes anything is unsafe, he should immediately advise his coach of such condition(s) and refuse to participate.

2. I acknowledge and fully understand that each participant will be engaging in activities that involve risk of serious injury, including permanent disability and/or death, and severe social and economic losses which might result not only from their own actions, inactions or negligence but the actions, inactions or negligence of others, the rules of play, or the condition of the premises or of any equipment used. Further, that there may be other risks not known to us or not reasonably foreseeable at this time.

3. I agree and assume all the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.

4. I release, waive, discharge, hold harmless and covenant not to sue the Camp, SUHSD, Trustees, Camp Staff, coaches, employees or agents from any and all liability, claims, costs or expenses to each of the undersigned, his or her heirs and next of kin for any and all claims, demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the releases or otherwise.

5. I further agree and authorize Camp staff or coaches to obtain all medical, surgical, diagnostic and hospital procedures as may be performed or presented by a physician for the above said participant if I cannot be reached in case of emergency.

I / WE HAVE READ THE ABOVE WAIVER AND RELEASE, AND THEREFORE; VOLUNTARILY UNDERSTAND THAT I / WE GIVE UP SUBSTANTIAL RIGHTS BY SIGNING BELOW. I / WE ALSO UNDERSTAND THAT CASCADE TEAM CAMP MAY TAKE PHOTOGRAPHS OF PARTICIPANTS & ACTIVITIES OF THE CASCADE TEAM CAMP AND MAY USE SUCH PHOTOGRAPHS RELATING TO PROMOTION OF FUTURE CASCADE TEAM CAMPS.  A copy of this agreement shall suffice as original.

 Medications, Allergies &/or Chronic Conditions (i.e. Asthma) ____________________________________________

Health Insurance Co.   _______________________________________________________________________________

Policy # ______________________________________________________ Group # ______________________________

Athlete’s Physician ___________________________________________ Phone ________________________________

X_____________________________________________________  Date ______/______/_____

Sportsmanship - Teamwork - Strength - Character - Discipline - Dedication