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CAMP RELEASE FORM

FREE YOUTH CAMP


Please Fill Out Completely and turn into a member of the Coaching Staff or Camp Personnel.

PLAYERS NAME

CURRENT SCHOOL & GRADE

CONTACT PHONE #
SELECT T-SHIRT SIZE

EMERGENCY CONTACT Adult

S M L XL XXL

EMERGENCY CONTACT PHONE # Youth

S M L XL

MEDICAL INSURANCE COMPANY POLICY NUMBER

KNOWN MEDICAL CONDITIONS

I hereby authorize the directors of the Liberty Baseball camp to act for me according to their best judgment in any
emergency requiring medical attention for my son/daughter. I hereby waive and release Liberty Baseball and its
coaches, Liberty High School, and Hillsboro School District 1J from any and all claims for personal injury. I
know of no physical or mental problems which may affect my son son’s /daughter’s ability to safely participate in
this clinic. I will be responsible for any medical and other charges in connection with her attendance at camp. I
have read this waiver and agree to its contents.

Parent / Guardian Signature: ____________________________________ Date: ______________________

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