Rhare breed training Camp registration

1. RHARE BREED TRAINING
DREAMCHASER CAMP REGISTRATION FORM
Participant Information
Last _________________________________ First_________________ MI ________
Address_________________________________ City___________________ State_____ Zip_____
Phone No:____________________________ Email______________________________________
Birth date_____________ Age:_______ School: ___________________ Grad Year ______
Position _______________________ T-SHIRT SIZE: M L XL
Parent/Guardian info:
Name:__________________________________ Relationship:__________________________
Address:(if different from above) _______________________________________________________________
City: __________________________ State: ____ Zip: ____________________
Primary Contact number: ____________________ Secondary: _________________________
Emergency Contact Information (if the parent/guardian can not be reached):
Name ____________________________ Relationship to Athlete______________________________
Home Telephone No:___________________ Cell or work No: _______________________________
Insurance information:
Name of Primary Medical Insurance Company:_______________________________ Policy Number: ____________________
Physician:___________________ Physician’s Phone Number: ___________________________________________
PARTICIPANT MEDICAL HISTORY:
Please list any and all Medical Conditions or Medications. ( limitations, history, allergies, etc.)
_________________________________________________________________________________________________________
________________________________________________________________________________________________________
________________________________________________________________________________________________________
PERMISSION AND WAIVER:
1. PERMISSION TO PARTICIPATE: I, the parent/guardian of the above-named participant hereby acknowledge that my child is in good general health and I give
my approval for my child to participate in any and all activities during the football camp.
2. INTENT TO INFORM: I acknowledge that I am fully aware of the potential dangers of participation in any sport and I fully understand that participation in
football may result in SERIOUS INJURIES, PARALYSIS, PERMANANET DISABILITY AND/OR DEATH. Furthermore, I fully acknowledge and understand
that protective equipment does not prevent all participant injuries, and therefore I do hereby waive, release, absolve, indemnify, and agree to hold harmless Rhare
Breed, and any and all organizers, sponsors, supervisors, participants, from any claim arising out of any injury to my/our child whether the result of negligence or for
any other cause.
3. EMERGENCY MEDICAL AUTHORIZATION: I hereby grant my permission for any and all emergency medical/dental treatment and/or first aid to be
administered to my child/participant, including authorizing any medical treatment facility/hospital to administer emergency treatment, for any illness/injury/accident
resulting from participation.
4 INSURANCE DISCLOSURE: I am aware that the camp organization carries group accident insurance, which is considered secondary or excess for medical
purposes to any and all valid insurance I possess is considered primary insurance. Furthermore, I agree to notify in writing the camp director of any medical claim as
a result of participation in the camp as soon as reasonably possible. I understand that any registration fee paid does not constitute a direct premium for insurance and
that a deductible(s) may apply.
RULES & REGULATIONS: - By my signature below, I hereby stipulate that I have read, fully understand and voluntarily agree to all of the above:
Signature of Parent/Guardian___________________________ Print Full Legal Name __________________________________
Date______________________________

2. Rhare Breed
Participant Media
Release Form
As parent/ guardian of (participant s name) _______________________________,
who will participate in an activity put on by Rhare Breed, I give permission
for my child to be included in photographs, digitally videotaped, and/or
audio recorded, and for the information collected to be used as part of
news stories and advertisements published in print, internet, broadcast, or
video by Rhare Breed.
I understand that images and/ or filmed/ audio recordings will not be used
for commercial gain and will not be sold to anyone for commercial use. I
also understand that my child reserves the right to refuse to be
photographed and/ or recorded, or participate in any documentation that
makes him or her feel uncomfortable or embarrassed.
Please indicate by checking the appropriate box below whether your child
has permission to be photographed or filmed.
Yes, I give permission.
No, I do not give permission.
Parent/Guardian Signature: _____________________________ Date: _______________