KYWEAR Skills Clinic

Please fill out the following form.

Players First name

Players Last name

Guardian First/Last Name

Players Shirt Size

Players Grade

Players Date of birth

Month

Day

Year

Has your child been hospitalized in the last 12 months?

Yes

Is your child suffering from a medical condition, illness or injury?

Yes

If you answered yes to any of the questions above, please supply additional information.

Initials

Multi choice

I am aware that participation in KYWEAR has some inherent risks and injury can occur.

On rare occasions these injuries can be serious. In consideration of my child being allowed to participate in the KYWEAR Skills Camp, I, the parent/guardian, assume the risk of all injury and agree not to sue KYWEAR, the camp directors, coaches, assistant coaches, agents, facilities or volunteers for any and all injuries caused by or resulting from participating in the KYWEAR Skills Camp.

By signing this waiver, I also authorize the use of pictures of the above-named participant to be posted on the KYWEAR web site or advertising media published by KYWEAR.

This is waiver is to protect KYWEAR and our facilities. If you sign this waiver we are not reliable for any injuries while particitpating in our camps.

I declare that the info I’ve provided is accurate and complete.

Signature

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KYWEAR Skills Clinic

$35