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PARENT/GUARDIAN INFORMATION

Release Agreement

I, [ParentGuardianFirstName] [ParentGuardianLastName], being the parent or legal guardian of the child requesting admittance, do hereby affirm that the applicant is in good health and suffer from no illness, disability, or condition that requires the taking of medicine on a regular basis unless the conditions are disclosed and approved. Furthermore, I have no knowledge of any reason the applicant can not participate in the vigorous physical activity.

I hereby expressly agree to be responsible for any medical bills incurred in the treatment of any illness or accident. In the event of any such accident or injury, I hereby consent to allowing any of the program supervisors to procure any medial treatment deemed advisable on behalf of my child or ward without prior consent. I understand that no primary insurance is provided by F.O.C.U.S Basketball Academy.

I understand that, as a condition of admittance to the program, I, on behalf of the applicant, hereby release Tim Barnett, Travis Williams, Jean Samsel, Scott Snider, Camp of Champions, Peyton Siva, Russ Smith, or anyone staffed by the camp from any and all liability from injuries, illness, mental or physical, suffered by the member during or related to the program, unless caused by a willful act or gross negligence by the person or entity against whom the claim is made.

Check here to accept the above Release Agreement.

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