KIIDS SUMMER SOCCER CAMP

Medical Information/Waiver and Consent Form

July 30, 2007 – August 10, 2007

 

Campers Name:_______________________________________________________

Campers Address:_____________________________________________________

Please list all prescription and over the counter medication being used by the camper: ___________________________________________________________________

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Set forth any special notes concerning the above medication:_____________________

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Please list any allergies: ___________________________________________________________________

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I acknowledge that the prescription medications noted above have been prescribed by _______________’s for use as prescribed on the label.

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The over the counter medications listed above are approved by me to be given to _____________________ as needed, and I hereby waive any liability on the part of KIIDS Inc. in the administration of the same.

 

Print: Parent/Guardian Name:___________________________________________

Parent/Guardian Signature:_____________________________________________  Date:_________________

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Parent/Guardian Consent and Waiver

I hereby represent that the above information is true and accurate and the named applicant is in good health and has my permission to participate in the KIIDS Inc. Summer Soccer Camp.  I acknowledge that soccer is a contact sport and that there is a risk of injury from participating in the camp and its related activities.  I hereby waive and release KIIDS Inc. and its agents, servants and employees from any and all liability and claims for damages.  In the event of an emergency I hereby give permission to such medical personnel as necessary to render treatment.

 

Print: Parent/Guardian Name:___________________________________________

Parent/Guardian Signature:_____________________________________________  Date:_________________

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Photography

There will be a photographer on site most days to take pictures of the children in action.  These pictures are available for purchasing and may be used to put into the Photos section of our website (www.kiidssports.com).  If you do not want pictures of your child to be put on our website please check here:____

 

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Please return Camp Application and Medical Information/Waiver and Consent form to:

KIIDS Inc., 1929 Commerce St., Suite 7, Yorktown Heights NY 10598