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Name:
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Phone number:
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Email address:
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Athlete Information
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Name of Athlete
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Athlete Age:
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Sport:
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*All Sessions begin June 11.
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Attending Which
Session:
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*Actual clinic is June 11-12. June 13 is reserved in case of inclement
weather.
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Past Injuries/Medical
Conditions:
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I hereby give permission for the above named athlete to participate in athletic activities. I realize
that anyone who participates in athletic activities in which the body and/or objects are in motion is
exposing themselves to a risk of severe injury, paralysis or even death, regardless of the use of
protective equipment, the utilization of standard coaching techniques and the observance of the
rules, these injuries can still occur. Acknowledging the aforesaid factors and realizing that
GOALWorks and it's officials have no responsibility to provide first aid at any athletic activity, the
parent/guardian understands that the risk of injury is assumed by the parent and athlete.
However, in the event physicians, physical therapists, physician assistants, nurses or other
persons trained in rendering of first aid are available, as volunteers or otherwise, and render first
aid to any student injured during the course of any such activities, then the parents do hereby
release and forever discharge such persons and GOALWorks and it's officials from any liability
arising out of any first aid or immediate treatment of injuries. I understand that my family
insurance plan is the first carrier in the event of medical expenses. I hereby state that my
son/daughter is physically fit to participate in the GOALWorks Clinic.
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Place X in the box if you have read and agree to the waiver.
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Place X in box if you have double checked your entries and
printed for your records.
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