Medical Release Form

1
Event Participating* This field is required.
Football Mini-Camp (February 21st, 2020)
Ultimate Football (Feb. 18-20th, 2020)
2
Event for Airtable
3
Year
4
Start Date of Event* This field is required.
Date
Month
Day
Year
5
End Date of Event* This field is required.
Date
Month
Day
Year
6
First Name (Participant's)
7
Last Name (Participant's)
8
Participant's Phone Number
Area Code
Phone Number
9
Participant's E-mail
10
School Currently Attending (or next year if summertime)* This field is required.
High School
Other
11
High School:* This field is required.
Akron
Albion
Alden
Allegany-Limestone
Amherst
Barker
Bennett
Bishop Timon
Buffalo Academy of Science
Buffalo Arts Academy
Burgard
Canisius
Cardinal O'Hara
Cattaraugus/Little Valley
Ch. Lake
Cheektowaga
Clarence
Cleve-Hill
Clymer
Depew
Dunkirk
East Aurora
East Community
Eden
Ellicottville
Franklinville
Fredonia
Frewsburg
Frontier
Global Concepts Charter
Gowanda
Grand Island
Hamburg
Health Sciences Charter
Hutch Tech
Inter Prep
Iroquois
Jamestown
JFK
Kenmore East
Kenmore West
Lackawanna
Lake Shore
Lancaster
Lew-Port
Lockport
Maple Grove
Maryvale
McKinley
Middle Early College
MST Prep
Newfane
Niagara Falls
Niagara-Wheatfield
North Tonawanda
Olean
Olmsted
Orchard Park
Panama
Pine Valley
Pioneer
Portville
Randolph
Roy-Hart
Salamanca
Sherman
Silver Creek
South Park
Southwestern
Springville
St. Francis
St. Joes
St. Mary's
Starpoint
Sweet Home
Tonawanda
West Seneca East
West Seneca West
West Valley
Williamsville East
Williamsville North
Williamsville South
Wilson
WNY Maritime
Other
12
Please Enter Name of School:
13
Team/School Name for Airtable* This field is required.
14
Year of Graduation
2019
2020
2021
2022
2023
2024
2025
2026
2027
2028
2029
2030
15
Year of Graduation for Airtable
16
Emergency Contact Name* This field is required.
First Name
Last Name
17
Emergency Contact Phone* This field is required.
Area Code
Phone Number
18
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:* This field is required.
Yes
No
19
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.)* This field is required.
ClearSignature for participant -Use your mouse to make the signature
20
Date of Signature* This field is required.
Date
Month
Day
Year
21
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:* This field is required.
Yes
No
22
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.)* This field is required.
ClearParent or Guardian Signature (Please use mouse to complete the signature)
23
Parent or Gardian Name
First Name
Last Name
24
Date of Signature
Date
Month
Day
Year
25
E-mail for confirmation to be sent:
Should be Empty: