Permission Slip and Medical Information for State Summer Games

Permission Slip and Medical Information for State Summer Games 2019 Games

  • I, as the Parent/Guardian give my expressed, written consent to any and all Coaches and volunteers of KCSO Family and Friends to take my child (athlete's name above) held Friday, June 7, 2019 through Sunday, June 9, 2019 at Illinois State University Campus in Normal Illinois. The undersigned acknowledges voluntary assumption of the risk of injury, damage or loss, both known and unknown, involved with participating in this trip including transportation to and from the activity, and I/we am/are prepared to solely assume all associated with participation in this trip. Therefore, in consideration of the permission extended to my child (athlete’s name above) to participate in this trips (I/we) and (my/our) agents, representatives, assigns, heirs, and successors, hereby release, hold harmless and indemnify the KCSO Family & Friends, it’s agents representatives, officers, assigns, and successors from any and all claims, demands, actions, or causes of action, whether developed or undeveloped, known or unknown, past, present, or future, including, but now limited to, any or all damages, costs, personal injuries, including death, disabilities, direct or indirect medical expenses, pain and suffering, and attorney’s fees arising out of or in any way connected with participation in this trip.

  • Typing your name here serves as online signature
  • Date Format: MM slash DD slash YYYY