Camper's Name (required)
T-Shirt Size (required)
Grade 2019/20 (required)
Parent's Medical Insurance Carrier (required)
Insurance Group # (required)
Insurance Policy # (required)
Parent/Guardian Emergency Contact Phone # (required)
Parent/Guardian Email (required)
Waiver and Release of Liability
Physical activity, by its very nature, carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injury. By signing the wavier set forth below you are acknowledging these risks as well as other potential risks are associated with physical activity and specifically associated the sport of football. I am aware of the risks, hazards and inherent dangers that may arise due to my child’s participation in the Manhattan High School Football Camp. In consideration for my child, _______________, being allowed to participate in said activity, it is agreed that all risks attendant to watching and/or participating in camp activities, including, but not limited to bodily injury, are assumedby the camper and his/her parents and/or legal guardian as indicated by the signature hereto. I hereby certify that the above named camper is physically able to participate in the camp and that I know of no physical impairments which would in any manner limit his/her participation in the program.I, for myself, and on behalf of my child, hereby release, waive and discharge Joseph W. Schartz, the other camp instructors, agents and employees from every claim, liability or demand of any kind sustained, whether caused by the negligence of the coaches/instructors or otherwise. This release shall be binding upon any heirs, administrators, executors and assigns of mine. I further agree to indemnify Joseph W. Schartz from any loss, liability, damage or cost it may incur due to my participation in said activity in any way. I also certify that I am the legal parent or guardian of the above named camper and have full right to provide this release. In the event of illness or injury resulting or arising directly or indirectly out of said activity, I hereby give myconsent and authorization for (1) the administration of emergency first aid care and treatment at the scene of an emergency by faculty, staff members or (2) the administration of any treatment deemed necessary by a licensed physician or dentist and (3) the transfer to any hospital reasonably accessible.
By submitting your signature below, you are not only accepting the terms of the authorization and waiver of liability set forth above your signature also indicates that you have read the camp brochure in its entirety.
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