Medical Release Form

Medical Release Form
Event Participating *

Dodgeball (Nov. 9th 2019) ASAP (Nov. 2019 - Mar. 2020)
Event for Airtable
Year
Start Date of Event *

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End Date of Event *

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Participant Information
First Name (Participant's)
Last Name (Participant's)
Participant's Phone Number

Area Code Phone Number
Participant's E-mail
School Information
School Currently Attending (or next year if summertime) *

High School Other
High School: *
Please Enter Name of School:
Team/School Name for Airtable *
Year of Graduation
Year of Graduation for Airtable
Emergency Contact Information
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone *

Area Code Phone Number

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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Date of Signature *

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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) Clear
Parent or Gardian Name

First Name Last Name
Date of Signature

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E-mail for confirmation to be sent:
Should be Empty:

Medical Release Form

Participant Information

School Information

Emergency Contact Information

Participant Signature

Parent or Guardian Signature