Insurance Release

I, as parent of , age , expressly authorize Georgetown College, Georgetown Community Hospital and/or any other medical doctor or medical institution which might render medical treatment to my child during the period of their participation in the Happy Osborne Player Development Camp, to release record of said treatment to the Georgetown College athletic trainer or it’s insurance carrier, in order that they might be better informed of my child’s medical condition and capabilities while participating in the Happy Osborne Player Development Camp. A photocopy of this authorization shall be considered as effective and valid as the original.

The health history contained in this form is correct to the best of my knowledge and the person herein described has permission to engage in all prescribed camp activities, except as noted by me and the examining physician. In the event that I cannot be reached in an emergency, I hereby give permission to the physician selected by the camp trainer to hospitalize, secure proper treatment for and to order injections, anesthesia, or surgery for my child as named above.

By submitting this form you are agreeing to the terms listed above.