*Parent's/Guardian's Emergency Contact Information

Parent(s) Name:

Home Phone:

Work Phone:

Alternative Emergency Contacts

Primary Emergency Contact Name:

Home Phone:

Work Phone:

Address:

Secondary Emergency Contact Name:

Home Phone:

Work Phone:

Address:

*Medical Information

Hospital/Clinic Preference:

Physician's Name:

Physician's Phone Number:

Insurance Company:

Policy Number:

Allergies/Special Health Considerations:

*Parent/Guardian Permission Release Agreement

I authorize all medical and surgical treatment, X-ray, laboratory, anesthesia, and other medical and/or hospital procedures as may be performed or prescribed by the attending physician and/or paramedics for my child and waive my right to informed consent of treatment. This waiver applies only in the even that neither parent/guardian can be reached in the case of an emergency.

I release Above The E. D. G. E. and individuals from liability in case off accident during activities related to Above The E. D. G. E. sports camp/programs, as long as normal safety procedures have been taken.

Waiver:
I understand that participation in Above The E. D. G. E. Camp and/or programs/activities is completely voluntary. Above The E. D. G. E., LLC shall not be liable and is release from any/all claims, injuries, or damages of whatever nature, incurred by the participant which are directly or indirectly attributable to the negligence (whether passive or active) arising out of, or in connection with programs/activities of Above The E. D. G. E. LLC, its agents or employees. On behalf of the participant, and myself I release and discharge Above The E. D. G. E. LLC from any such claims, injuries or damages, which also includes any injuries that may result from the condition of facilities used for the Camps, programs and/or activities.

Media Release:
Above The E. D. G.E. LLC may take pictures, slides, and videos of participants enjoying the Camps, programs, and/or activities for use in marketing and promotion of agency programs. I grant permission to use the name, pictures, and quotes of the participant, for the above purpose. If I do not consent, I will send a letter to Above The E. D. G. E., LLC, stating my wishes.

Data Privacy:
The data supplied to Above The E.D.G.E. LLC will be used to enroll the participant/s in Camp recreation, program, and/or activities, which includes some requested private data. This data is only available to the participants Parent/Guardian and Above The E.D.G.E. LLC administration and/or staff who need this information to perform their duties, but is not available to the public. You are not legally required to provide this data, but Above The E.D.G.E. LLC administration and/or staff may not be able to complete your registration and/or you may not receive update or necessary information.

Parent's Name