Arizona Sports Camp Medical Release Form
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ARIZONA SPORTS CAMP MEDICAL RELEASE
Please print or type:
PARTICIPANT’S NAME
Mailing Address

Street Address

City/State/Zip

Daytime Phone

Parent/Guardian

Evening Phone

IN CASE OF EMERGENCY AND PARENT/GUARDIAN CANNOT BE CONTACTED, PLEASE NOTIFY:
Name

Relationship

Phone #

Medications currently taking
Known allergies (Including any medications)
Medical conditions (Diabetes, Epilepsy, or any other aspect that would affect the participant’s full
involvement in the sport/activities)

Are there any medical or other conditions that may affect emergency care?

If you have medical insurance, please list carrier and policy #
I have provided (circle one) Tylenol, Aspirin, Advil, Ibuprofen, other
for my son’s/daughter’s
use for minor aches/pains, to be used within the judgment of Arizona Sports Camp staff/personnel. My
permission is granted with my signature:
Date:
I am aware that the very nature of athletic participation carries with it an inherent risk of injury. l understand
that the dan