Parent Consent

I/We acknowledge that the participant is assuming a certain risk of being injured: that even the best coaching and strict observance of the rules, injuries may occur. Blackford High Schools, the staff, and anyone else affiliated with the BYBL are not responsible for such injuries, participants will be covered by the participants family insurance. I hereby grant camp staff to have my daughter treated by a staff member or by a physician if necessary. My/our daughter is physically fit, according to our family physician.

Parent Signature of Release. _____________________

Date__________

Participants Name___________________________  Parent/Guardian_________________

Address__________________________

_________________________________

Phone #_________________________

Emergency #_____________________    Family Doctor____________________

Age_____ Grade_______

(Youth) S(6-8)___ M 10-12) ___  L(14-16)___