People authorized to pick up camper from camp

Name *

In the event of an emergency, requiring medical attention, I hereby grant consent to a physician, athletic trainer and/or other qualified medical personnel to provide medical treatment to and/or transport my child. I understand every effort will be made to contact me to receive my authorization before treatment will be undertaken. However, in the event on an emergency and if I cannot be reached, I give my consent to the medical care provider to perform any necessary emergency treatments, I agree to release any records necessary to the appropriate medical care provider for the purpose of treatment referral, billing or insurance.

In consideration for registration of my child listed above to the Mini Cub Camp and Panther Prep, I do hereby agree to release, discharge and hold harmless the St. Johns County District, its officers, agents, employees, volunteers, and booster organization from all causes, liabilities, claims, damages or demands resulting from injury or accident involving my minor child while attending camp. I understand that all participants must be covered by medical insurance and that the district does not provide such insurance for camp/clinic/tryout participants. *

Dietary Restrictions - A snack will be provided. If your camper has food allergies, please pack a snack that means their needs. *

Participant Name (First and Last

Email *

State *

City *

Emergency Medical Release: In the event on an emergency

Family Name

Grade for 26-27 School Year