Conwell Egan High School

Camper Information

Camper Name: *

Grade (Sept 2024): *

Current School: *

Shirt Size: *

Parent/Guardian Name: *

Parent/Guardian Phone: *

Parent/Guardian Email: *

Emergency Contact Name: *

Emergency Contact Cell: *

Relation To Camper: *

Physician: *

Allergies/Health Concerns:

Explain any physical restrictions:

Walking To and From Camp: *

Camper Name: *

Grade (Sept 2024): *

Current School: *

Shirt Size: *

Parent/Guardian Name: *

Parent/Guardian Phone: *

Parent/Guardian Email: *

Emergency Contact Name: *

Emergency Contact Cell: *

Relation To Camper: *

Physician: *

Allergies/Health Concerns:

Explain any physical restrictions:

Walking To and From Camp: *

Camper Name: *

Grade (Sept 2024): *

Current School: *

Shirt Size: *

Parent/Guardian Name: *

Parent/Guardian Phone: *

Parent/Guardian Email: *

Emergency Contact Name: *

Emergency Contact Cell: *

Relation To Camper: *

Physician: *

Allergies/Health Concerns:

Explain any physical restrictions:

Walking To and From Camp: *

WAIVER: *

I hereby assume all risks related to participation in the Conwell-Egan Catholic Girls Volleyball Camp. I release myself, heirs and executors for injury or illness which may result from my child’s/children’s participation. I further state that my child is in proper physical condition to participate and compete in the camp and any activities surrounding the camp.

PHOTO RELEASE
I grant permission for my child to be photographed, filmed, videotaped or otherwise recorded and for my child’s likeness, image, appearance, and/or voice to be used in Camp materials, productions made by or on behalf of Conwell-Egan, or in advertising or trade in promoting and publicizing the Camp, Conwell-Egan, or its or their operation, affiliates, and business partners.

Photo/Video Release: *

LIABILITY RELEASE
I/We being the parents(s) or legal guardian(s) for, above named child(ren) hereby give Conwell-Egan Catholic High School (CEC) staff permission to administer basic first aid when applicable, including the treatment of minor cuts, scrapes, burns (including sunburns) and stings. Medication will not be administered by CEC staff at any time. I hereby give permission to medical personnel and Emergency Medical Services selected by the staff of CEC to provide transportation and treatments, including X-rays and routine tests, for my child. In the event that I cannot be reached in an emergency, I hereby give permission to the physician/hospital where my child is transported to secure and administer treatment, including hospitalization and surgery, for my child. The completed forms may be photocopied for trips out of camp. I agree to assume financial responsibility for all medical and hospital expenses.

On behalf of the child/minor, I hereby release, discharge and hold harmless, Conwell-Egan Catholic High School, and their employees from and against all losses, claims, actions, costs, expenses and or damages, including attorney fees, arising out of my/out child's participation in the Girls Volleyball Camp, except for the willful misconduct or gross negligence of Conwell-Egan.

*

I/We have carefully read this release prior to its execution and I/We fully understand its contents.

Parent/Guardian Signature: *

Relationship to the child(ren): *