212.724.3278

Camp Medical Form

RELEASE AGREEMENT
I, the parent or guardian of the below-mentioned child hereby consent to his/her participation in the Fastbreak Kids program. I certify that he/she is in good health and able to participate in all activities and in the case of emergency affecting my child, I hereby give permission for physician or hospital designated by Fastbreak Kids to administer treatment to my child. I (am/am not) enclosing a note explaining any physical limitations and required medicine. In consideration of Fastbreak accepting this registration and permitting the participation of said child, which I believe would be educational, physical and beneficial, I hereby release, discharge, indemnify and hold harmless Fastbreak Kids its officials, coaches and representatives from any and all claims, actions and liabilities arising out of or in connection with the child’s participation in any aspect of Fastbreak. I also give permission to Fastbreak to use photographs and/or endorsements of above named child and/or parents in its future brochures, websites or promotional material.

PRESCRIPTION DRUG POLICY
Fastbreak Kids will not dispense prescription medication.

By signing this release, I understand that Fastbreak does not give refunds for missed camp days or cancelled registrations.