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Minor Medical Authorization, Assumption of the Risk and Photographic Waiver

THIS FORM MUST BE COMPLETED PERSONALLY AND VOLUNTARILY BY A PARENT OR LEGAL GUARDIAN OF THE MINOR NAMED BELOW FOR PARTICIPATION IN THE EVENT

: 12/31/2010 - Minor Medical Form
 
Minor Information:
Competitor's Name(first/last):
Parent or Legal Guardian's Name (first/last):
Address Line 1:
Address Line 2:
City, State, Zip:
Person Responsible for child at regatta
Emergency Contact Name
Relationship
Emergency Contact Cell Phone
Emergency Alternative Phone Work or Home
Cell phone if different than above
Sailing Partners last name (NA if not applicable)
Name of Boat or NA
Issues or allergies which medical personnel should be aware of, be specific as to which child
 
Email:
 
Medical Authorization, Photographic Waiver and Assumption of the Risk Liability Waiver
I acknowledge and accept the following statement:
MEDICAL AUTHORIZATION
I, the above listed parent or legal guardian of the above listed competitor(s), minor(s), do hereby authorize and consent to such medical or dental treatment services or care which are necessary or appropriate for my child(ren), including the selection of medical personnel and facilities and transportation or transfer of my child(ren) to such facilities and in connection with such treatment, services and/or care, to authorize and consent in my name and on my behalf to such emergency or necessary surgery, diagnostic or corrective, as they may determine to be necessary for the life, health or well being of my child(ren), after reasonable consultation with duly licensed physicians, surgeons and /or dentists. It is understood that reasonable effort shall be made to contact the undersigned prior to rendering treatment of my child(ren) but that any of the above treatment will not be withheld if the undersigned cannot be reached.
PHOTOGRAPHIC WAIVER
Furthermore, I understand that by my child(ren) participating in Sail Newport events, I automatically grant to the Organizing Authority and its sponsors the right in perpetuity to make, use and show, from time to time at their discretion, any motion pictures and live, taped or filmed television and other reproductions of him or her or them during the period of the competition without compensation.
ASSUMPTION OF THE RISK
I, the above listed parent or legal guardian of the above listed competitor(s) acknowledge that my child intends to participatce as a youth competitor in the 2010 Youth Challenge Regatta and/or the 2010 UDOSA New England Championship. The undersigned specifically asserts that the minor competito will comply with the RRS of Sailing and rules and regulations of the event. I will make certain that my child is provided with a Coast Guard approved life jacket and will wear it at all times while on the docks or on the water. I am aware that participation in a sailing event presents the risk of serious injury and even death. I acknowlege that the risks exist and assume said risks with respect to practicing or participating in a Sail Newport sailing event either on the water, on the docks or on shore.
 

 
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