In consideration of the Participant being allowed to participate in this camp/clinic, I hereby release, indemnify, and hold harmless Winston Salem State University and its Board of Trustees, the entity operating this camp/clinic, and their respective members, officers, employees, agents, and volunteers (collectively, “the Releases”), and the successors and assigns of the Releases, regarding all claims, demands, costs, expenses, and causes of action whatsoever, including those resulting from Releases’ negligence, arising from the Participant’s participation in the camp/clinic, including but not limited to personal injury, illness, property damage or property loss. This includes overnight stays on campus, if applicable.

I understand that this activity involves risk to the Participant. I further acknowledge and understand that due to the nature of this activity, there is a possibility that the Participant may sustain physical illness or other (minimal, serious, catastrophic, death) in connection with the Participant’s participation. I acknowledge and understand that I am voluntarily and knowingly assuming the risk of physical illness or injury resulting from participation in this camp/clinic.

I hereby acknowledge that I am responsible for medical charges incurred during sports camp/clinic participation. I hereby give my permission to a certified athletic trainer to supervise on-site first aid and/or illness requiring medical diagnosis or treatment. I hereby give my support for sports staff to secure the appropriate medical care, including transportation and hospitalization if necessary. Every attempt will be made to notify the parent or guardian of the need for any medical attention beyond minor first aid.

Facts About Sickle Cell Trait: Sickle cell trait (SCT) is an inherited condition that affects the oxygen-carrying protein, hemoglobin, in the red blood cells. Sickle cell trait is a common medical condition that is most predominate in African-Americans, but people of all races and background may test positive. Sickle cell trait is generally benign, and almost all of the 3 million Americans with sickle cell trait live healthy normal lives. However, during maximal exercise the oxygen levels in muscles can decrease sufficiently to cause some of the red cells to change from the normal disk shape to a crescent or sickle shape. These sickled red blood cells can block blood vessels in muscles, kidneys, and other organs resulting in severe damage to the involved tissues and even death.

I understand and acknowledge that the WSSU Athletic Department recommend that all athletes wishing to participate in any WSSU athletic camp have knowledge of their sickle cell trait status.

Additionally, I have read and fully understand the aforementioned facts about sickle cell trait and sickle cell testing. Recognizing that my true physical condition is dependent upon an accurate medical history and a full disclosure of any symptoms, complaints, prior injured, ailments, and/or other disabilities experienced, I hereby affirm that I have fully disclosed in writing any prior medical history and/or knowledge of sickle cell trait status to the WSSU Sports Medicine Staff.

I do not wish to undergo sickle cell trait testing and I voluntarily agree to release, discharge, indemnify and hold harmless Winston-Salem State University, its officers, employees and agents from any and all costs, liabilities, expenses, claims, demands, or causes of action on account of any loss or personal injury that might result from my non-compliance with the recommendation of the WSSU Sports Medicine Department.