Medical Acknowledgement, Waiver, And Consent And Release For Emergency

Created by Nicole Craig
Feb 19, 2019

I acknowledge that a physician has examined my registered athlete, within the past 12 months of participation with Las Vegas Gators Youth Track Club training and competitive seasons. Furthermore, I acknowledge that said physician has certified that said athlete has been cleared to participate and complete in the various athletic activities related to track and field events, contests, and competitions. I do hereby give my consent for the above athlete to participate in Las Vegas Gators Youth Track Club program. I THE UNDERSIGNED HEREBY WAIVES AND RELEASES any and all claims I may have against The Las Vegas Gators Youth Track Club, officers, directors, employees, volunteers, and agents, or representatives FROM ANY AND ALL LIABILITY DUE TO PERSONAL INJURY RESULTING FROM ACTIVITIES SPONSORED BY Las Vegas Gators Youth Track Club, OR FOR WHICH Las Vegas Gators Youth Track Club IS A PARTICIPANT. Moreover, I authorize the coaching staff or assigned chaperones of Team Las Vegas Gators Youth Track Club to act as Spokesperson in granting permission for emergency treatment/hospitalization (including anesthesia), if necessary for the aforementioned athlete and to make any decisions concerning the health, welfare and safety; including medical treatment of this athlete during my absence. I understand that should a health emergency arise, I will be notified, but if I cannot be reached by telephone, such medical treatment as deemed necessary by competent medical personnel is authorized.