PARENTAL CONSENT AGREEMENT & WAIVER FORM
Medical information is included in the information below, there is no separate form:

PARENTAL CONSENT:  The undersigned, being a parent or legal guardian of the young person requesting camp admittance, does hereby affirm that the applicant is in good health and suffers from no illness, disability or condition that requires the taking of medication on a regular basis unless that condition is disclosed and approved.  Furthermore, the undersigned has no knowledge of any reason the applicant cannot participate in vigorous physical activity.
I understand that as a condition of admittance as a camper, the undersigned, as parent and guardian, and on behalf of the applicant, hereby releases the Heritage Soccer Booster Club, Heritage High School, RCPS, and all other employees or agents of the camp from any and all liability from injury or illness, mental or physical, suffered by the camper during or related to camp, unless caused by willful act or gross negligence by the person or entity against whom the claim is made.
“Rockdale County Public Schools does not sponsor/endorse the activity and/or information contained in this flyer. RCPS assumes no responsibility for conduct or safety during the activity/event.  In consideration for the privilege to distribute these materials, the RCPS shall be held harmless from any cause of action, claim or petition filed in any court or administrative tribunal, arising out of distribution of these materials, including all costs, attorney’s fees, judgments or awards.  Rockdale County Public Schools encourages parents to assist their children in making choices appropriate for them.”
By signing the registration form, you agree to the above terms and conditions.

REGISTRATION FORM
Child’s Name ________________________________

Age_____  Gender______Birthdate______________

Address____________________________________

___________________________________________

Phone______________________________________

Parent’s Name_______________________________

Parent’s Cell Phone___________________________

Parent’s Email_______________________________

T-shirt size __________________________________

My child ____________________has my permission to participate in the Junior Patriots Soccer Camp held at Heritage High School on June 6-10.   I will not hold HHS school, RCPS school system, coaches, players, HHS Soccer Booster Club or any other party related to this soccer activity for any accident/injury that may take place during this camp.

Parent Signature ____________________________

Print & mail (with payment and registration form) to:
ATTN: Chad Suddeth
Heritage High School
2400 Granade Rd.
Conyers, GA 30094