Puyallup, wa 98371

C/O 1615 34th st se

JAGUARS “4 YARD” FOOTBALL CAMP
PARENT CONSENT AND RELEASE FORM JAGUARS “4 Yard” FOOTBALL CAMP
(A) I/WE HEREBY GIVE CONSENT FOR MY SON/
DAUGHTER TO PARTICIPATE IN THE 2011
JAGUARS “4 YARD” FOOTBALL CAMP.
(B) I/WE KNOW OF AND ACKNOWLEDGE THAT
MY SON/DAUGHTER KNOWS THE RISKS
INVOLVED IN PARTICIPATION IN SUCH A
ONEHeart
CAMP, AND WE/I UNDERSTAND THAT SERIOUS
INJURY IS POSSIBLE IN SUCH PARTICIPATION ONEVoice
AND CHOOSE TO ACCEPT ANY AND ALL
RESPONSIBILITY FOR HIS/HER SAFETY AND
WELFARE WHILE PARTICIPATING. WITH FULL
UNDERSTANDING OF THE RISKS INVOLVED,
ONETeam
I/WE RELEASE AND HOLD HARMLESS
JAGUARS “4 YARD” FOOTBALL CAMP,
COACHES, ADMINISTRATORS, AND FACILITIES
AS WELL AS ANYONE INVOLVED IN THE
ADMINISTRATION OF THIS CAMP. I AGREE TO
RELEASE THE JAGUARS “4 YARD” FOOTBALL
CAMP FROM ALL RESPONSIBILITY AND
LIABILITY FOR ANY INJURY OR CLAIM
RESULTING FROM PARTICIPATION, AND
AGREE TO TAKE NO LEGAL ACTION AGAINST
DUE TO ANY OF THE ABOVE BECAUSE OR
MISHAPS INVOLVING THE PARTICIPATION OF
MY SON AND/OR DAUGHTER.
(C) THE PUYALLUP SCHOOL DISTRICT IS NOT A
SPONSOR OR AFFILIATED WITH JAGUARS “4
YARD” FOOTBALL CAMP IN ANY WAY.
(D) MY SIGNATURE GIVES PERMISSION TO
JAGUARS “4 YARD” FOOTBALL CAMP TO
SEEK PROFESSIONAL MEDICAL
ATTENTION IF NEEDED IN CASE OF AN
INJURY. FOOTBALL CAMP FOR K-9
(E) I HAVE READ THIS CAREFULLY AND KNOW
IT CONTAINS A RELEASE.
Student/Athletes
DATE_________________________________________ July 11, 12, and 13 2011
INSURANCE CARRIER_________________________

POLICY NUMBER______________________________

CARRIERS PHONE#____________________________

PARENT SIGNATURE __________________________

PRINT NAME HERE____________________________

“BUILDING CHAMPIONS FIRST”