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ADDITIONAL MANDATORY WAIVER IS REQUIRED FOR PARTICIPATION IN
THE OSU SUMMER SKILLS CAMP
Additional requird Waiver of Liability,
Assumption of Risk, and Indemnity is required by The Ohio State University prior
to the first day of Camp.
Agreement is included in the Confirmation
Packet. Additional signed agreement form is required for participation in
the Camp.
____________________________________________________________
I understand that I am required to have
accidental medical coverage for the child listed on this application, and I
verify that the information provided on this form is accurate and true.
I understand and agree that if I do not have
accidental medical coverage for the child listed on this application, I will be
financially responsible for all charges and fees incurred in the rendering of
said treatment.
In case of an injury, I authorize Camp Officials
to render first aid and/or obtain whatever medical treatment he deems necessary
for the welfare of my child listed on this application. I further
understand and agree that I will be financially responsible for for all charges
and fees incurred in the rendering of said treatment, regardless of whether my
medical insurance would cover such charges and fees.
I understand that at the discretion of the Camp
Supervisor and Staff my child may be dismissed from the Camp, without refund,
for inappropriate behavior. Furthermore, any damage to property or injury
to individuals from such an action could result in legal proceedings.
I understand that at the conclusion of the
scheduled Camp time the program and Staff are no longer responsible for my
child.
I give permission to use, reprint, and produce
any photographs or videos taken of me or my child and written materials
supploied by me or my child in the form of evaluations during the Camp.
_____________________________________________________________________________________________________
Signature of Parent of Minor
Date
_____________________________________________________________________________________________________
Signature of Participant
Date
Ohio State University Rugby Club
2008 Rugby Skills Camp
2045 Brofford Drive, Columbus, OH 43235
614-761-8171 | Fax: 614-761-8051
buckeyes@osurugby.com
Questions? Contact Coach Tom Rooney,
rooney@osurugby.com, 614-325-1515 |
