Medical Release Form
Event Participating
*
Varsity Passing Tournament (June 29th)
JV Passing Tournament (July 24th)
Summer Sports Camp (July)
Start Date of Event
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Month
-
Day
Year
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End Date of Event
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-
Month
-
Day
Year
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Participant Information
Participant's Name
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First Name
Last Name
Participant's Phone Number
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Area Code
Phone Number
Participant's E-mail
School Information
School Name
*
Year of Graduation
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
Emergency Contact Information
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone
*
-
Area Code
Phone Number
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Participant Signature
Cross Training Athletics has my permission to use any photos or video taken of me during camp for instructional purposes and/or publicize future events:
*
Yes
No
Cross Training Athletics (CTA) does not provide medical insurance for participants of any of their events or functions. In the event of illness or injury requiring treatment or hospitalization, family medical insurance must be used. Parents will be billed directly for any medical care given at the local hospital. I understand that I may sustain an injury to the extent of broken bones, sprains, strained, chipped or lost teeth, paralysis, or even death. In understanding this, I do hereby release Cross Training Athletics and their respective employees, members and volunteers from any liability in the event of accident, injury or death. The above information has been explained by the CTA Staff and I and my parent/ guardian understand that I am participating at my own risk. CTA does not insure any injury that may occur during the event on or off the field. Lastly, I understand that Cross Training Athletics is a Faith-based, Non-profit organization that will share Biblical truth. By signing in the area below, I am stating that I am in agreement with these terms. (Please use your mouse to make your signature.)
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Signature for participant -Use your mouse to make the signature
Clear
Date of Signature
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Month
-
Day
Year
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Parent or Guardian Signature
REQUIRED IF PARTICIPANT IS 17 YEARS OLD OR YOUNGER
Cross Training Athletics has my permission to use any photos or video taken of my child during for instructional purposes and/or to publicize future events:
*
Yes
No
Cross Training Athletics (CTA) does not provide medical insurance for participants of any of their events or functions. In the event of illness or injury requiring treatment or hospitalization, family medical insurance must be used. Parents will be billed directly for any medical care given at the local hospital. I understand that I may sustain an injury to the extent of broken bones, sprains, strained, chipped or lost teeth, paralysis, or even death. In understanding this, I do hereby release Cross Training Athletics and their respective employees, members and volunteers from any liability in the event of accident, injury or death. The above information has been explained by the CTA Staff and I and my parent/ guardian understand that I am participating at my own risk. CTA does not insure any injury that may occur during the event on or off the field. Lastly, I understand that Cross Training Athletics is a Faith-based, Non-profit organization that will share Biblical truth. By signing in the area below, I am stating that I am in agreement with these terms. (Please use your mouse to make your signature.)
*
Parent or Guardian Signature (Please use mouse to complete the signature)
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Parent or Gardian Name
First Name
Last Name
Date of Signature
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Month
-
Day
Year
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E-mail for confirmation to be sent:
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