WORLD RECORD CAMPS

PARTICIPANT INFORMATION

Participant Name: Date of Birth:

Address:

City, State, Zip:

Phone: Email:

PARENT/GUARDIAN INFORMATION

Parent/Guardian Name:

Relationship to Participant:

Phone: Email:

EMERGENCY CONTACT (if different from above)

Name: Relationship:

Phone:

MEDICAL INFORMATION

Does the participant have any of the following? (Check all that apply)

☐ Allergies (food, medication, environmental):

☐ Asthma or breathing conditions

☐ Diabetes

☐ Heart condition

☐ Seizure disorder

☐ Previous concussions or head injuries

☐ Joint/bone injuries or conditions

☐ Other medical conditions:

Current Medications:

Physician Name: Phone:

Insurance Company: Policy #:

LIABILITY WAIVER & ASSUMPTION OF RISK

I, the undersigned parent/guardian of the above-named participant, acknowledge and agree to the following:

1. Assumption of Risk: I understand that participation in World Record Camps athletic training activities involves inherent risks, including but not limited to: physical injury, sprains, fractures, concussions, heat-related illness, and other injuries that may result from athletic activity. I voluntarily assume all risks associated with my child's participation.

2. Release of Liability: I hereby release, waive, and discharge World Record Camps, its owners, directors, employees, volunteers, coaches, clinicians, sponsors, affiliates, and venue providers from any and all liability, claims, demands, actions, or causes of action arising out of or related to any loss, damage, injury, or death that may be sustained by the participant, whether caused by negligence or otherwise, while participating in World Record Camps activities or while on premises owned or controlled by World Record Camps.

3. Indemnification: I agree to indemnify, defend, and hold harmless World Record Camps and its representatives from any and all claims, damages, losses, or expenses (including attorney's fees) arising from my child's participation in camp activities or any breach of this agreement.

MEDICAL AUTHORIZATION & CONSENT

I hereby authorize World Record Camps staff to:

• Provide or arrange for first aid treatment
• Transport the participant to a medical facility if necessary
• Consent to medical treatment, including emergency medical or surgical treatment, if I cannot be reached immediately
• Share relevant medical information with emergency responders and medical professionals

I understand that I am financially responsible for any medical expenses incurred.

CONCUSSION PROTOCOL

I understand that if the participant sustains a suspected concussion, cardiac event, or serious injury during camp activities, they will be immediately removed from participation. Return to activity requires written clearance from a licensed medical professional.

PHOTO/VIDEO RELEASE

I grant permission to World Record Camps to photograph, film, and record camp activities and to use the participant's name, image, likeness, and voice for promotional, educational, and marketing purposes, including on websites, social media, and printed materials, without compensation.

☐ Check here if you DO NOT grant permission for photo/video use

CODE OF CONDUCT ACKNOWLEDGMENT

I acknowledge that I have read and understood the World Record Camps Code of Conduct and agree that the participant will abide by all camp rules and expectations. I understand that violation of camp rules may result in dismissal without refund.