Player Name *

First Name

Last Name

Which clinic is your player planning to attend? *

9:35am-10:05am- Boys Clinic

10:20am-10:50am - Boys Clinic

11:05am-11:35am - Girls Clinic

11:50am-12:20pm - Girls Clinic

1:35pm-2:05pm - Boys Clinic

2:20pm-2:50pm - Boys Clinic

3:50pm-4:20pm - Girls Clinic

4:35pm-5:05pm - Girls Clinic

Parent Name *

First Name

Last Name

Authorization *

I authorize the staff of the clinic to use their best judgment in allowing my child to receive emergency medical or surgical treatment if necessary. I understand that every effort will be made to contact me prior to such action. (PLEASE BE ADVISED THAT IT IS IMPERATIVE THAT YOUR CHILD BE IN GOOD HEALTH WHEN ARRIVING AT CLINIC. THE DUTIES OF CLINIC PERSONNEL CANNOT INCLUDE PROVIDING MEDICAL CARE PERTAINING TO EXISTING INJURIES OR ILLNESSES AND WITH THE EXCEPTION OF EMERGENCY SITUATIONS.) I hereby: 1. certify that, to the best of my knowledge, the medical information is complete and correct. 2. agree to assume all risk of personal injury arising from participation in this tournament, understanding that this sport does involve the potential for injury. 3. agree not to hold the staff responsible for any injury sustained during tournament participation. 4. agree not to make any claims or demands against clinic staff or 4 the Future Foundation for any injury sustained. 5. agree to allow the Clinic Director to use his/her judgment in obtaining necessary medical care, at the expense of the parent. 6. agree to accept any decisions made by the Clinic Director in terminating attendance due to unacceptable behavior.*

Yes, I agree