2016 Football 2 Faith Camp

Mercy Street 4th Annual Football 2 Faith Camp!  Friday, June 24th and Saturday June 25th at Pinkston High School 2200 Dennison St., Dallas, TX 75212. Registration starts at 8am!

Friday, June 24th ages 7 - 13 from 9am - 4pm
Saturday, June 25th ages 14 - 18 from 9am - 4pm

Name *
Name
Address *
Address
Phone *
Phone
Please list any medical conditions, food or drug allergies, current or previous injuries and any medication(s) that your child uses regularly. (If there are no known conditions that you are aware of, please indicate by writing NONE).
Emergency Contact *
Emergency Contact
Emergency Number *
Emergency Number
Liability waiver
I, as the parent or legal guardian of the minor named above, hereby agree, on behalf of my child and myself, to assume all of the risks in connection with my child’s attendance at and participation in the Football 2 Faith football camp. I do hereby waive, release, absolve, indemnify, and agree to hold harmless, Mercy Street, staff, coaches, sponsors, volunteers, participants, for any claim arising out of an injury to my child, whether the result of negligence or any other cause and the cost of medical services. I hereby grant permission to the Football 2 Faith football camp to administer first aid, secure proper treatment, and/or hospitalize my child in case of emergency, provided they are unable to communicate with me, and according to their best judgment. I, as the parent or legal guardian of the named minor, hereby authorize any licensed physician, emergency medical technician, paramedics, nurses, or hospital or other medical or health care facility or provider (“Medical Provider”) to provide medical care to the minor participant for any injury and/or condition that occurs, manifests or arises at the Football 2 Faith football camp or related activities. I further authorize any Medical Provider to perform all procedures or services deemed medically advisable to treat or relieve, or to attempt to treat or relieve any illness, injury, and/or condition including but not limited to the administering of pain relief medication and/or triple antibiotic ointment. I acknowledge that there is a possibility of complications and unforeseen consequences in any medical treatment, and I knowingly and voluntarily agree to assume such risk for and on behalf of myself and/or said minor. I acknowledge that the attending physician, appropriate staff, and the Football 2 Faith football camp, Mercy Street and its employees and camp volunteers shall not be responsible in any way for the consequences from said diagnostic, medical and/or surgical treatment and are hereby released from any and all claims and causes of action that may arise, grow out of, or be incident to such diagnosis, treatment, or surgery insofar as the law allows and provided that these services are performed with ordinary care to the best of their ability. I have read this release and fully understand its contents. I am aware that this is a release of liability and a contract between the Football 2 Faith football camp, Mercy Street and me and I sign it of my own free will. I agree that the minor participant is capable of participating in camp or program activities except as otherwise noted below. I authorize the Football 2 Faith football camp and Mercy Street to take, have, use, publish and reproduce photographs, video, or other images or sounds of my child for their records / archives and /or for advertising, promotional or informational purposes including without limitation for its camp brochures, on its website, or for any promotions efforts, and I hereby waive and release on behalf of my child any rights of compensation for, or ownership of any such images and / or sounds of my child. This document contains the entire agreement between the parties to this agreement and the terms of this document are contractual and not a mere recital. The information I have provided is disclosed accurately and truthfully. I understand that football is a contact sport and it is possible that the camp participant could be injured while participating in the camp. I acknowledge that I have been given ample opportunity to read this document and I understand and agree to all of its terms and conditions. I further acknowledge that I am signing this document freely and voluntarily, and intend by my signature to provide a complete and unconditional release of all liability to the greatest extent allowed by law. I hereby agree and acknowledge that the laws of the State of Texas shall govern this agreement.

For additional information contact Lee Jackson at lee@mercystreetdallas.org or 214-730-4830.