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Field Hockey Camp and Clinic Release Form


As a parent or guardian, I also agree that I or my insurance carrier will bear the financial responsibility for any medical treatments administered which might be over the insured level of the clinic plan. The clinic does not assume responsibility for illness or injuries sustained during clinic. I affirm that my child had a physical examination within the last calendar year and is physically fit to participate in all clinic activities. In the event of illness or injury requiring medical attention and I cannot be contacted at the phone number(s) listed, I hereby authorize the clinic directors to act for me according to their best judgment. I relieve the clinic of any responsibility for any illness or any injuries that may occur. The clinic is not responsible for lost valuables or money. Now, therefore, in consideration for my son/daughter being allowed to participate in this activity, I agree for myself and my son/daughter to indemnify and hold the supervisor(s) and coordinator(s) of this activity, Saint Francis University, its Board of Trustees, agents, officers, and employees, and student volunteers harmless for any and all direct, indirect, special or consequential damages, or costs, legal and otherwise, which they may incur as a result of my son/daughter's participation in this activity(ies), even if due to the negligence of Saint Francis University or any person serving in the above-identified capacities even if the claim is brought by my son/daughter on their own behalf. I have read the above terms of this agreement/release, and I understand and voluntarily agree to the terms and conditions. This agreement/release shall be binding upon the heirs, executors, and assigns of the undersigned.


Signature of parent or guardian:



Medical Conditions:

Known Allergies:


Health Insurance Co.:

Name: Policy #: