Medical Liability Release

Camper’s First Name * :

Camper’s Last Name * :

Camper Date of birth

Street address

City

State

Zip Code

Camper email address

Parent Contact Information

First Name * :

Last Name * :

E-Mail

Phone Number

Street address

City

State

Zip Code

Alternate Parent First Name

Alternate Parent Last Name

Alternate Mobile Phone Number

Alternate Email Address

Not Applicable

All physical activity inherently carries some risk of injury, and certain types of activity are not appropriate for persons with limiting medical/health conditions. Participant is aware of the risk and knowingly and voluntarily assumes the risk of these injuries, regardless of severity, which may occur due to participation in the Camp/Clinic described herein. Participant represents that participant is in the necessary physical condition to participate and have the requisite knowledge to safely participate.

If participant is injured or needs medical attention, the Camp/Clinic Staff will obtain: whatever medical or ambulance service is needed to clear the medical emergency; however, it is understood that participant is responsible for the cost of these services.

Participant hereby releases Pinnacle Performance Training and Consulting and all employees of said camp, Maryland Athletics, the University Maryland, State of Maryland, all state departments, Agencies, Boards and Commissions, and their respective officers, employees, agents, or representatives from any and all liability, claims, cost, expenses, injuries, illness, or loss resulting from, in whole or part, including attorney fees, participant’s participation in the University of Maryland Softball Camps/Clinics described herein.

I, the undersigned, am at least eighteen (18) years of age and have read this release form and understand all its terms. If I, the undersigned, am under the age of eighteen (18) years, in addition to my signature, my parent or legal guardian also shall state his/her having read, signed, and understand this release form and all its terms.

Date

Participant’s Signature *

Date

Parent or Guardian Signature *

Health Form

* I confirm that I have read this Release and fully understands its terms. I have had the opportunity to ask questions and those questions have been answered to my satisfaction. I have signed the Release freely and without any inducement or assurance of any nature and I intend the Release to be a compete and unconditional release of all liability to the greatest extent permissible by law.