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Team Camp Medical Form

Print and Bring Individual Copy For Each Player Attending Camp

Medical Information

Date of last Tetanus Immunization
Any Allergies to medicines?
If so, please list

Any Conditions physicians should be aware of?

Person to notify in case of emergency

Family Health Insurance:
Policy Holder and Policy Number
Company Name and Address

I hereby authorize any actions which may be advised/recommended by a trainer, physician or other health care provider attending my child during camp.  I acknowledge and understand that my child may sustain physical illness or injury (minimal, serious or catastrophic), in connection with this camp.  I agree to indemnify and hold harmless Player's Edge Volleyball, its officers, employees and agents from and against any claims for personal illness or injury that my child may sustain during camp, regardless of cause, including negligence on the part of any person identified above.  I also give Player's Edge Volleyball permission to utilize any photograph of my child for promotional use.  I also understand that my child must abide by the camp rules and regulations and code of conduct developed for this camp.  I also understand that my child's failure to adhere to the rules, regulations, and code of conduct may result in immediate dismissal from camp, with no refund, and I will be responsible for providing transportation home once I have been notified.
I also understand that by checking the box below on this application serves the same purpose as my signature and that I understand all rules and regulations involved.
I have read, understand and  explained the Code of Conduct regulations to camper.

Parent or Guardian Check