Mt Hood Community College
Clinic Release Form
Parental/Guardian Release and Information
Note: This form must be completed in FULL, including authorization checked by parent or legal guardian.
Campers will NOT BE ALLOWED to participate without completion of this form. Separate forms are needed for each camp.
Parental / Guardian Release
- Give permission to the above named camper to attend and participate in the Mt. Hood Basketball Camp referenced above.
- Give permission to the camp staff to render preventative, first aid or emergency treatment, or all of the foregoing, necessary to camper’s health and well-being. In the event of serious injury/illness, the need for major surgery, or significant accidental injury, I understand an attempt will be made by the camp staff to notify the designated emergency contacts as soon as possible. If camp staff is unable to communicate with me, the treatment deemed necessary for camper’s health and well-being may be given.
- Certify that, to the best of my knowledge, the medical information requested above is complete and correct, and that no health related situations preclude camper’s participation in camp activities.
- Agree to assume all risk arising from camper’s participation in camp activities, including but not limited to any activities that may present risk of bodily injury.
- Agree to save, hold harmless, discharge and release Mt. Hood Community College for any and all liability, claims, and causes of action, damages or demands in connection with camper participation in camp activities including transportation to, at, or from camp activities.
- Understand that any medical expenses for Camper’s health and well-being will be the responsibility of the parent/guardian.
- Agree to accept any decisions made by the Camp Director in the termination of camp attendance due to unacceptable or unsafe behavior and agree to forfeit reimbursement of any camp fees and pay any associated costs relative to the decision.
- Authorize the camp staff to administer medications to my child (as prescribed by physician) as indicated on this form.
- Certify that I am the camper’s parent or legal guardian. On behalf of myself and my spouse, partner, co-guardian or any other person who claims the participant as a dependant, I have read the above Parental Guardian Release and Information. I understand the contents of this Parental Guardian Release and Information, assent to its terms and conditions, and check and type my name of my own free act.
By checking this box I agree the typed name below is in replacement for my signature.
For questions contact Head Men's Basketball Coach Nate Bowie
Phone: 503-491-7451 or Nathan.Bowie@mhcc.edu