AUTHORIZATION TO CONSENT TO TREATMENT OF A MINOR

I THE UNDERSIGNED AS PARENT/LEGAL GUARDIAN OF _______________________________ Do Hereby authorize the Maverick Football camp or its employees, directors, coaches, officials, and adult volunteers, ("Camp Staff') to provide routine health care, administer prescribed medications as needed, administer non-prescribed over-the counter medication, consent to an X-ray, examination, anesthetic, medical, dental, or surgical diagnosis or treatment and hospital, including emergency room, care (collectively referred to as "medical care") to be rendered on the Minor under the general or special supervision and upon the advice of a physician or surgeon licensed under the laws of the State of California.

THE UNDERSIGNED UNDERSTANDS AND AGREES that the Camp, the La Costa Canyon High School Foundation, and its directors, officers, employees, and agents ("Foundation") shall not be legally or financially liable for any bill or medical expense incurred or any cause of action or claim arising from any medical care or the lack of medical care.

THE UNDERSIGNED AGREES TO INDEMNIFY, DEFEND, AND HOLD HARMLESS the Camp and the Foundation from any claim made by or behalf of the Minor or the Minor's heirs, parents/guardians arising out of any medical care provided.

Date________ Parent/Guardian___________________________

IS THE CHILD COVERED BY MEDICAL INSURANCE: ____ YES_____NO INSURANCE COMPANY NAME:________________________________

POLICY NUMBER:_________________________

EMERGENCY CONTACT INFORMATION

Parent/Guardian: ______________________________________________ _________________________________________

Home Telephone Other Telephone

Non-Parent/Guardian _______________________________________________ __________________________________________

Home Telephone Other Telephone

I hereby voluntarily and without compensation authorize the Camp to record and use the likeness of my child and to publicize and display such likeness without notice or payment of any royalty, fee, or compensation of any character to me for the use of the likeness.

RELEASE AND WAIVER OF LIABILITY

I understand that my child ___________________________________ has enrolled in the Maverick Football camp ("Camp") that is to take place at La Costa Canyon High School. I understand that there are risks associated with participating in the Maverick Football camp, which could include the risk of injury to person and/or property, including death.

In consideration of being allowed to participate in the Camp and related events and activities, I the undersigned parent/guardian of the child named above do hereby acknowledge, appreciate, and agree to as follows:

I __________________________________________ HEREBY RELEASE, WAIVE, DISCHARGE FOREVER, AND COVENANT NOT TO SUE

the La Costa Canyon High School Foundation, its directors, officers, agents, employees, and any and all Camp sponsors, officials, coaches, volunteers, and others involved in the Camp (hereinafter "Releases") from all liability to the undersigned or such children and all his or her personal representatives assigns, heirs, and next of kin for any loss or damage and any claim or demands therefore on account of any and all injury to person or property, including death, to the undersigned or such children while the undersigned or such children are attending the Camp or related activities.

THE UNDERSIGNED FURTHER AGREES TO INDEMNIFY AND SAVE AND HOLD HARMLESS the Releases and each of them from any loss, liability, damage or cost (including attorneys fees) the Releases may incur as a result of attendees' attendance at the Camp or any related activity thereof.

The UNDERSIGNED further expressly agrees that the foregoing RELEASE, WAIVER, and INDEMNITY AGREEMENT is intended to be as broad and inclusive as is permitted by the law of the State of California and that if any portion thereof is held in valid, it is agreed, that the balance shall continue in full force and effect.

THE UNDERSIGNED WARRANTS that he/she has no knowledge of any physical impairment that would be affected by the attendee's participation in the Camp.

THE UNDERSIGNED HAS READ AND VOLUNTARILY SIGNS THE RELEASE AND WAIVER OF LIABILITY AND INDEMNITY AGREEMENT, and further agree that no oral representatives, statements, or inducements not contained in this Waiver have been made.

Parent/Guardian Signature ________________________________Date _________