Emergency Contact Name
Alt. Phone Number
Do any of the participants have any allergies, chronic illness, or medical conditions?
Are any of the the participants prescribed an inhaler?
I hereby give my approval for my child’s participation in any and all activities prepared by LEAP
Enterprise LTD during the selected camp. In exchange for the acceptance of said child’s candidacy by
LEAP Enterprise LTD, I assume all risk and hazards incidental to the conduct of the activities, and
release, absolve and hold harmless LEAP Enterprise LTD, and all its respective coaches, mentors,
youth workers, officers, and representatives from any and all liability for injuries to said child arising
out of traveling to, participating in, or returning from selected camp sessions.
In case of injury to said child, I hereby waive all claims against LEAP Enterprise LTD. including all
coaches and affiliates, all participants, sponsoring agencies, advertisers, and, if applicable, owners
and lessors of premises used to conduct the event. There is a risk of being injured that is inherent in
all sports activities, including football, cricket, basketball and multi-skills. Some of these injuries
include, but are not limited to, the risk of fractures, paralysis, or death.
As Parent and/or Guardian of the named participant, I hereby authorise the diagnosis and treatment
by a qualified and licensed medical professional, of the minor child, in the event of a medical
emergency, which in the opinion of the attending medical professional, requires immediate
attention to prevent further endangerment of the minor’s life, physical disfigurement, physical
impairment, or other undue pain, suffering or discomfort, if delayed.
Permission is hereby granted to the attending physician to proceed with any medical or minor
surgical treatment, x-ray examination and immunisations for the named participant. In the event of
an emergency arising out of serious illness, the need for major surgery, or significant accidental
injury, I understand that every attempt will be made by the attending physician to contact me in the
most expeditious way possible. This authorisation is granted only after a reasonable effort has been
made to reach me.
Permission is also granted to LEAP Enterprise LTD and its affiliates including Directors, Coaches,
volunteers and Team Parents to provide the needed emergency treatment prior to the child’s
admission to the medical facility.
Release authorised on the dates and/or duration of the registered activity.
This release is authorised and executed of my own free will, with the sole purpose of authorising
medical treatment under emergency circumstances, for the protection of life and limb of the named
minor child, in my absence.
• Please note that to help promote and evaluate LEAP Enterprise LTD activities, there may be video
filming and photography at some sessions which may be used in publicity materials e.g. leaflets,
newsletters or on official websites. LEAP Enterprise LTD advises all activity providers to ensure that
images are not accompanied by names or other details that could identify individuals. I DO / DO NOT
give permission to be filmed or photographed during LEAP Enterprise LTD activities as described
above (Please delete as appropriate)
Please indicate the following: ---Please Select---I will be waiting to pick up my child.I will be happy for my child to make their own way home.I will be dropping off my child and another parent/guardian will be escorting back to my home.
BY ACKNOWLEDGING AND SIGNING BELOW, I AM DELIVERING AN ELECTRONIC SIGNATURE THAT
WILL HAVE THE SAME EFFECT AS AN ORIGINAL MANUAL PAPER SIGNATURE. THE ELECTRONIC
SIGNATURE WILL BE EQUALLY AS BINDING AS AN ORIGINAL MANUAL PAPER SIGNATURE.
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