Parent Authorization and Emergency Contact Information
WRESTLERS WILL NOT BE ALLOWED TO PARTICIPATE IN CAMP WITHOUT THIS COMPLETED FORM
The health of the person described above is excellent and has my permission to engage in all prescribed Camp activities, except as noted by an examining physician or me.
In the event I cannot be reached in an EMERGENCY, I hereby give my permission to the physician selected by the Camp Director or Trainer to hospitalize, secure proper treatment for, to order injection, anesthesia, or surgery for my child named above.
Please list any medicine the wrestler may be allergic to, or any camp activity (listed on the general information and rules sheet) he/she should not participate in:
Physical Exam For the health safety of the participant, it is strongly recommended that wrestlers have a physical examination within the year prior to attending Camp.
MEDICAL INSURANCE (STRONGLY RECOMMENDED FOR ALL WRESTLERS)
THE CAMP ASSUMES NO FINANCIAL RESPONSIBILITY FOR MEDICAL OR DENTAL EXPENSES IN ANY WAY RELATED TO THE AZEVEDO WRESTLING CAMP.
Hospitals and doctors DO require insurance or payment in case of treatment. Please list YOUR insurance company and policy number below:
I understand that my child named above will be participating in vigorous athletic activities, which present potential risks of serious injury. On behalf of my minor child and all those related to my minor child, I hereby agree that we shall assume the risk of any injuries that may result from my child’s participation the Azevedo Wrestling Camp and program. In consideration of being allowed to participate in any way in the Azevedo Wrestling Camp, the undersigned: Agrees that prior to participating he/she will inspect the facilities and equipment to be used, and if he/she believes anything to be unsafe, he/she will immediately advise coach or supervisor of such condition(s) and refuse to participate.
I acknowledge and fully understand that the participant will be engaging in activities that involve risk of serious injury, including permanent disability and death, and severe social and economic losses which might result not only from their own actions, inaction, or negligence or others, the rules of play, or the condition of the premises or of any equipment used. Further that there may be other risks not known to or is not reasonably foreseen at this time. Assume the foregoing risks and accept personal responsibility for the damages following such injury, permanent disability or death.
I release, waive, discharge and covenant not to sue the Azevedo Wrestling Camp and AMA Wrestling Inc., its affiliated clubs, respective administrators, directors, agents, coaches, and other employees of the organization, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners, and lessors of premises used to conduct the event, all of which are hereinafter referred to as release”., agents and affiliated companies, from demands, losses or damages on account of injury, including death or damage to property, caused or alleged to be caused in whole or in part by the negligence of the release or otherwise. I have read the above waiver and release and understand that I have signed it voluntarily.
Upon submission of above form you will be contacted by an Azevedo Wrestling staff member for confirmation and payment.