RELEASE FORM

Dear Parent/Guardian:

Your child _______________________________will participate in the Ozanam Basketball Camp.  We (I) hereby release Ozanam, its directors, officers and volunteers, from any and all claims due to any injuries, harm, damages or losses from any source, whether related or unrelated to Ozanam, to my person and/or property foreseen, or unforeseen, patent or latent that could arise as a result of participation in the Ozanam Basketball League.  I have read this release and it is freely and voluntarily executed by me.  I do not rely on any inducements, promises, or representations made by Ozanam or its agents or representatives.

Our (my) child, ________________________________ is covered by a personal insurance policy, or is included in my program.  I hereby authorize routine medical care for my child and I authorize treatment not considered routine to be referred to local physicians at my expense.

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Application, Parental Permission and Medical Form

Your Name_________________________________________________
Date of Birth _______________________________________________

School__________________________ Grade___ Ht .____Wt. _____

Home Address ____________________________________________
Phone__________________________________________

City/Town _______________________________ Zip Code __________

Parent/Guardian to contact in Case of Emergency

Name_______________________________________________________

Phone________________________ Cell Phone: ____________________