all fields must be completed

I/We, the undersigned hereby certify that I (we) am (are) the parent or legal guardian of the camper. I hereby give permission for the staff of the Camp to seek during the period of the Camp appropriate medical attention for the camper and for medical attention to be given and for the camper to receive medical attention in the event of accident, injury, or illness. The camper has medical insurance under our policy. I will be responsible for any and all costs of medical attention and treatment except for that covered by my insurance coverage. I/ We understand that soccer is an active, physical sport, and that injuries can take place during play. I/ We also understand there will be a number of children attending camp, there will be a limited number of coaches and/or counselors, and that our child can not receive individualized attention and supervision at all times. I/We understand that, as with any sport, injuries, even death can occur, and we hereby confirm that our child is physically fit and mentally capable of participating in soccer and camp activities. I / We We also understand that it is my our responsibility in caring for the camper listed above, to be assured that he/she is fully capable of engaging in this sport’s activity, and I/ we are confident that he/ she is able to engage in such sport. I/ We, the undersigned for ourselves, our heirs, executors and administrators, waive, release and forever discharge Washington University, Chaminade H.S., and the Joe Clarke Soccer Camps, and their respective staff, officers, agents, employees, representatives, successors and assign of and from all rights and claims for damages, injury, or loss to person or property which may be sustained or occur during participation in Camp activities or while at Camp, whether or not damages, injury, death or loss is due to negligence. Type in name and date indicating agreement to the above*