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Elon University - Women's Lacrosse

Elon Women's Lacrosse Camp

Liability Waiver & Medical Release Statement

To participate in camp it is required each camper print the Release and Medical Authorization form and bring with you to camp!

The release and the treatment authorization must be signed by a parent or guardian if student is under 18 years old. Students who are 18 years old or will become 18 years old before the end of the camp/clinic must also sign. In order for students to participate in camp activities, we must have this form prior to the camp’s start date. Otherwise, parent or guardian must be contacted prior to release to participate.

Print Medical Release Form()

Liability Waiver & Medical Release Statement

The undersigned, being a parent or legal guardian of the child requesting camp admittance, does hereby affirm that the applicant is physically able to perform activities conducted at the Elon Girls Lacrosse Camp and I hereby authorize any medical evaluation or treatment which may be advised or recommended by qualified medical personnel of my child while at the Elon Girls Lacrosse Camp. In consideration of my application being accepted, intending to be legally bound, do hereby for myself, my heirs, executors and administrators waive and release and forever discharge any and all claims for damages, which I may have or may hereafter occur to me against Elon University, the Lacrosse program or their respective officers, agents, representatives, successors and/or assigns for any or all damages which may be sustained or suffered in connection with my association with, or participation in, the Elon Girls Lacrosse Camps on the campus of Elon University. I, the parent or guardian, do hereby agree to the above waiver and release.

List any allergies: ______________________________________________

List any medical conditions: ______________________________________

Insurance Company: ____________________________________________

Policy Holder: _________________________________________________

Policy Number: ________________________________________________

Complete Address or Complete Phone Number of Insurance Company: _______________________________________________________________________

Signature of Parent/Guardian: _____________________________________

Date: _________________________