Men's Soccer College Prep Clinic - August 9, 2019

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T-Shirt Size *
Class *
Soccer Position *

Medical History/Treatment Consent

The camp will take place at Drass Field at Scott D. Miller Stadium in Dover, Del. In case of any emergency & to enable the camp &/or the area health facilities to provide prompt care to your child please complete this form: This way, we can help your child without delay in an emergency.

Is the above-named presently taking any or will need to take any medication during camp? *
Is the above-named currently being treated for an illness or injury? *
Does the above-named camper have asthma? *
I certify that my child is in good health and can participate in all activities of the camp. *

Treatment Consent Form: I/We the undersigned, hereby grant permission to the above-named to attend and participate in the College Prep Soccer Clinic, held on August 9, 2019. Furthermore, I hereby give permission to the camp staff and/or emergency medical staff to render preventative first aid and/or emergency treatment that they deem necessary to my child’s health and well being. In the event of serious illness, the need for major surgery or significant accidental injury, I understand that an attempt will be made by the camp staff to notify the emergency contacts (parent/guardian to be first contacted). If unable to contact above emergency contacts, the treatment deemed necessary for my child’s best interest and well being may be given. I understand that this authorization is given in advance of any specific diagnosis, treatment or hospital care and that is given to provide the Clinic staff authority to seek medical treatment (including 911 calls) and to provide a licensed health care provider the authority to administer this treatment they judge necessary (including surgery, x-ray exams and anesthesia) to the above-named camper.

As a reminder, the fee is $55 to participate in the clinic.

Waiver Form: I/We the undersigned, hereby grant permission to have my above-named child participate in the College Prep Clinic on August 9, 2019. I/We, for ourselves, heirs, executors and administrators waive, release and forever discharge Steve Clark, Wolverine Soccer & Wesley College & any additional staff from all rights and claims for damages, injury or property that may occur during the participation in or during camp activities.

* required field