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First Name

Last Name

Name of School

Grades

Adult Shirt size

Phone Number (Ex: 9541234567)

Email Address

Emergency Contact Name

Emergency Contact Phone (Ex: 9541234567)

Any allergies (If yes please list below)

Any medical condition or injuries (If yes please list below)

Indemnification and Liability waiver

This document is a waiver and release of liability. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, the undersigned does hereby release,acquit and forever discharge Ronald Blair III, AMI Concierge LLC, Greene County High School, USA Football and their officers, directors, partners, agents, sponsors, employees, coaches, trainers, players, counselors, physicians, insurers, successors and assigns and all other persons, organizations, and corporations affiliated therewith (collectively referred to as the "Releasees"), and each of them, of and from any and all liability, claims, demands damages, actions or causes of action, suits or causes of suit, arising from or involving, in whole or in part, the negligence or gross negligence of any one or more of the Releasees, that undersigned has now or may have in the future by reason or any cause or thing whatsoever which has occurred or might occur in the future, and specifically, without limitation of the foregoing, of and from any and all claims for property damage or personal injury, death, disability, loss of income or other damages arising out of or relating to the undersigned's minor child's participation in Ronald Blair III’s All Star Youth Football Camp.

Parent/Guardian Name