In case of Emergency, please notify (Name). (Phone #). PARENT STATEMENT OF AGREEMENT. ASSUMPTION OF RISK, LIABILITY RELE
Robinson ISD ROBINSON GIRLS’ BASKETBALL CAMP 2017 DATES: June 12th, June 13th and June 14th, 2017 / (Incoming 1st-9th grades) TIME: 1:00pm to 4:00pm COST: $50.00 LOCATION: Robinson High School Gymnasium STAFF: Robinson High School Basketball Coaches & Special Guests *ALL CAMPERS WILL RECEIVE A T-SHIRT* Make checks payable to: Send registration form and fee to: Robinson High School Attention: Keith Smith 700 W Tate Robinson, TX 76706
Robinson ISD
For more information call:
Keith Smith 512-934-7855
[email protected]
You can also drop your form off at any Robinson School Office. Name of Participant ____________________________________________________________________________________ Last First Address____________________________________________________________________________________________________________________________ City__________________________________________________________________________ Name of Parent or Guardian________________________________________________ Telephone Numbers___________________________________________(DAY) Birth Date_____________________________________
Age______________
School Grade (2017-2018)__________________________
In case of Emergency, please notify 1.
2.
(Name)______________________________________________________ (Phone #)___________________________ PARENT STATEMENT OF AGREEMENT ASSUMPTION OF RISK, LIABILITY RELEASE, INDEMNIFICATION AND REFUND POLICY Release and Indemnification: I hereby recognize and acknowledge that my child’s participation in recreational activities may involve bodily and/or emotional injury to myself and/or my child. In consideration of my child being permitted to participate in such events, I, for myself, my child, my heirs, my executors and administrators, hereby voluntarily and knowingly indemnify and hold harmless, defend, release, waive and discharge Robinson ISD, and its officers and employees and volunteers from any and all suits, claims or liability, including negligence, based on any injury except that caused solely by the willful misconduct of Robinson ISD activities. In addition, I agree that I or my insurance company will pay for medical, hospitalization or any other expenses resulting from my child’s participation. By signing this assumption of risk, liability release, and indemnification, I acknowledge that I have read its contents and disclosure, that I understand its contents and disclosure, and that I agree to its terms.
__________________________________________________________________________ Signature (Parent or Legal Guardian)
T-shirt Size (Circle One) Yth Small OFFICE USE ONLY….
AMOUNT PD.
Yth Med.
Yth Lrg DATE
Adult Small
______________________________ Date
Adult Med.
Adult Lrg
Adult X-Lrg
