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_______________________________________________________________
(My
child) has my permission to participate in the
activities at the Rick Johansen / Texas Wesleyan
University Volleyball camp.
In consideration of my child's attendance at
Camp, I understand I am accepting full responsibility
for my child. If
an accident should occur injuring my child, including,
but not limited to, death or serious injury, I on behalf
of myself, my heirs or successors, hereby release Rick
Johansen / Texas Wesleyan University, and their
trustees, directors, officers, agents, employees,
counselors, or students from any liability.
I understand that any expenses incurred for
medical treatment of my child will be my responsibility.
I agree on behalf of myself and my heirs and
successors to indemnify and hold harmless Rick Johansen
/ Texas Wesleyan University from any loss, cost,
judgment, or other harm, including attorney fees, which
might come to the arising from my child's attendance at
the Rick Johansen / Texas Wesleyan University Volleyball
camp. I grant permission for the Rick Johansen / Texas Wesleyan
University to photograph, record, or video my child
during Camp and to use those materials for promotional
or other purposes.
I hereby give permission to the
Rick Johansen / Texas Wesleyan University volleyball
camp to make any and all arrangements deemed appropriate
and in the best interests of my child for medical,
surgical, and dental care.
In the event I cannot be reached in an emergency.
I hereby give permission to a health care
provider to secure and administer treatment, including
hospitalization, for my child.
I understand that parental permission is required
for operative procedures on minors.
By signing this form, I am giving my permission
that operative procedures may be promptly carried out.
I understand that the Rick Johansen / Texas
Wesleyan University Volleyball camp is not responsible
for my child's pre-existing injuries or illnesses or any
aggravation of these conditions. In understand that the Rick Johansen / Texas Wesleyan
University Volleyball camp will not assume
responsibilities for illness or injury incurred while my
child is participating in Camp activities. I authorize release of any medical information to process
insurance claims and request payment of benefits of the
physicians or supplier for service.
Signature:
________________________
Date:
______________
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