Medical Condition/ Allergies:
I hereby authorize the staff of Southwest Juniors Volleyball Club to act on my behalf in any emergency situation that pertains to my child in which she may require medical attention. I hereby waive and release Southwest Juniors and Lamar Consolidated ISD from any and all liability for any injury or illness incurred while at a volleyball camp, clinic, tryout or practice. I have no knowledge of any medical problem or physical impairment that would affect the above named player in safely taking part in any and all volleyball camps, clinics, tryouts and/or activities. I certify that the above named player is covered by a medical insurance policy in case of illness or injury.
Medical insurance company:
