Matador Running Camp

Parent Permission and Medical Release

I have read the Matador Running Camp Information Sheet and Guidelines and  give  my  permission  for my  son/daughter

                                                                                                 to attend the Matador Running Camp at Clair Tapaan Lodge, 19940 Donner Pass Rd. Norden, CA .  I fully understand that this is not an official activity of Miramonte High School, and therefore recognize that the school cannot be held responsible for any damages.  I also agree not to hold any of the individuals involved with the organization of this activity liable for any damages or losses incurred during the Matador Running Camp. 

In the event that I cannot be reached, I hereby authorize the coach in charge, as agent to the child, to give consent to any diagnosis, treatment, and hospital care which is deemed advisable by and is rendered under the general or specific supervision of a physician licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment be rendered at the office or hospital.

In the event we experience problems with transportation to and from camp would you be able to help?        Yes            No

Signature of Parent/Guardian                                                                                                                                                                 

Home Phone                                           Work Phone                                               Email                                                                   

Person & Phone Number of person to be contacted if parent/guardian is not available

Name                                                                         Home                                                 Work                                                         

Medical Insurance Carrier & Policy #                                                                                                                                                   

Physician                                                                                Phone                                                                                                                    

Allergies (Including medication and foods)                                                                                                                                            

Please list any medications currently taking                                                                                                                                          

Please list any major operations or injuries/conditions of a serious nature                                                                                           

I have read the Matador Running Camp Information Sheet and Guidelines and agree and commit to following the rules and procedures.

                                Signature of Participant