Parental Consent & Medical Treatment Form (8-13 years old) - 2018 Day One Campers (8-13 years old) Full Name*Participant's Email (9 - 12th Graders Only)*Camp T-Shirt Size* M L XL XXL Participant Age*Address*CityStateZip CodeSchool Attending*Parent/Guardian Name*Parent/Guardian Email*Parent Phone #'s*Does your child have any allergies to food and/or medication? Yes No Is your child allergic to any medication (Make him/her itch, break out in a rash, or have trouble breathingList the allergies and medicationsPhysician's NamePhysician's Phone #Emergency Contact*Emergency Phone Number*Does your child have a chronic illness? Yes No Which illness?Does your child take any medications? Yes No Which Medication?Insurance CompanyPolicy NumberSponsoring OrganizationWaiver Yes No I/We, the undersigned, do hereby authorize that certified medical centers/hospitals are given the authority to render necessary medical services to my/our child(ren) which result, directly or indirectly, from his/her participation in events and/or activities sponsored by the Hampton Roads Youth Foundation: and I/we, the undersigned; also hereby agree to be responsible for such charges that are made by such medical center/hospital, doctor, etc., in providing such medical services as are referred to above. I/We do hereby waive any and all liabilities that the Hampton Roads Youth Foundation, its agents or representatives may incur as a result of any injury or other misfortune which may befall my/our child while engaged in the Hampton Roads All-Star Football Camp sponsored by the Hampton Roads Youth Foundation. I/We consent to have photographs and videos taken of my/our child that may be used for camp promotions. I/We also grant the National Football League and each of its my member football clubs, NFL Ventures, L.P., each of their parents, subsidiaries, affiliates, successors and assigns, and each of their respective shareholders, officers, directors, employees, agents, representatives and licensees (collectively, the “NFL Entities”) the irrevocable, perpetual, worldwide and royalty-free right, but not the obligation, to photograph, film, videotape, record and otherwise use my child’s name, voice, portrayal, performance, appearance, actions, likeness and/or biographical information, whether alone or in conjunction with others. NameThis field is for validation purposes and should be left unchanged.