Name ________________________________
Phone (        ) _________________________

Name ________________________________
Phone (        ) _________________________

I am the parent or legal guardian for the child in this registration form, and grant permission for the volunteer staff of the Youth Football Camp to act on my behalf for my child in granting
permission for evaluation and treatment or minor medical problems. I understand that should a major medical problem arise, attempts will be made to reach me by telephone at the number(s) I have listed. In the event I cannot be reached, I hereby give my consent to such medical treatment as deemed necessary by a licensed physician. I understand that the Norfolk Sheriff Foundation, a
501(c)(3)charitable foundation, does not provide any accident and medical insurance and that I will be financially responsible for any and all medical expenses related to injuries sustained during the camp. I have actual knowledge of the inherent dangers, risks and injuries involved in football, a contact sport. In addition, I, for myself, my child, my heirs, and personal representatives, hereby waive, release, and discharge forever any and all claims for damages for bodily injury, death, or damage or loss of property in any way related to my child’s participation in this camp, that I or my child may have or that may accrue subsequently to me or to my child against any and all departments or divisions of the Norfolk Sheriff Foundation, the City of Norfolk, the Commonwealth of Virginia, Maury High School, and Norfolk Public Schools, and all employees and agents of such entities. Further, I hereby give to the Norfolk Sheriff Foundation and its agents permission and a release to use my child’s name and photograph to promote and advertise the football camp in the future.  I have read, or have had read to me, this permission and waiver of claims statement and understand and voluntarily agree to its provisions.


Parent/Guardian Signature_______________________________

Parent/Guardian print name______________________________