2013 Davies Eagles Summer Hockey Camp

PLAYER NAME______________________________Position_________

Year in School 2013/2014

FR SOPH JR     SR

PARENTS NAME ____________________________________________

PARENTS NUMBER  _________________________________________

*NO PLAYER MAY PARTICIPATE IN CAMP* WITHOUT THIS SIGNED FORM ON FILE

INFORMED CONSENT AND LIABILITY

I recognize that there are certain risks, which are inherent in ice hockey activities. I further recognize that these risks cannot be eliminated regardless of the care taken to avoid injuries. On my own behalf, and on behalf of my child and on behalf of my successors, representatives, family,

Heirs, assigns, and estates, I acknowledge and understand that the decision to participate in the camp places the child at risk of serious injury, illness, and liability. I voluntarily accept and assume all risks arising out of my child’s participation in the camp’s activities, including, but not limited to property damage, personal injury, and death. I request that my child (identified above) be permitted to participate in an activity and agree to the following: In consideration for my child’s participation in this activity, on behalf of myself and my child, I waive, release, discharge, indemnify, and hold harmless the Camp, coaches, volunteers, employees and agents from all liability, claims, cost and expenses arising out of these activities which may result in injury or illness to my child.

I further agree that Brian Davidson is authorized to obtain and authorize emergency medical treatment for my child up to and including emergency hospitalization. I agree to be personally responsible for any related medical expense.

I also release camp staff from any claims for the loss of personal property.

Parents

Signature: _____________________________________Date_____________________________

*Make all checks payable to

DAVIES HOCKEY

4803 47^TH AVE SO

FARGO ND 58104

Registration in Due May 10, 2013