Newman Smith High School Summer Conditioning Medical Injury Waiver
Name__________________________________
Age________ 2008-09 Grade_______
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Address__________________________________________________________
City______________________
Zip_________________
Contact Number ___________________________
E-mail________________________
2008-09 School Attending
_________________________________________________
I as a parent or guardian, herby give permission for my child
to participate in the Newman Smith High School conditioning program and acknowledge
the fact that he is physically able to participate in camp activities. I hereby authorize the directors and coaches
of the Newman Smith High School conditioning program to act for me in any
emergency requiring medical attention, and acknowledge that I will be
responsible for any cost (through family medical insurance or otherwise)
incurred due to sickness or injury to my son.
I herby waive any claim that I might have against the Newman Smith High
School Summer Conditioning and the Institution providing the facilities.
Signature of Parent/Guardian
______________________________Date ____________