Colonial Classic Waiver and Consent
2018 WAIVER FORM
Colonial Classic: Hope for the Cure Tournament MEDICAL TREATMENT CONSENT & WAIVER
I, the legal guardian of the registered player, authorize the Robert Morris University Staff to seek medical treatment for the player as they see necessary. I consent to an x-ray, anesthetic, medical or surgical diagnosis or medical treatment and hospital care subsequently deemed necessary by a licensed health care provider including but not limited to physicians, physical therapists, and athletic trainers during the player’s session. I understand that this authorization is given in advance of any specific diagnosis, treatment, or hospital care, and that it is given to provide the staff authority to seek medical treatment and to provide a licensed health care provider the authority to administer this treatment as they judge necessary to the above named child. I accept responsibility for payment of all services rendered; I authorize any medical facility, which renders services to release medical information necessary for the processing of insurance claims; and I authorize the payment of insurance claims directly to the medical facility. I understand that whenever possible, the Robert Morris University Staff will make a good faith effort to contact me at the phone number listed on the player registration form before seeking treatment. If this is not possible, I understand that the Robert Morris University Staff will notify me as soon as possible of any and all diagnoses and treatments.
Having read this waiver and knowing these facts and in consideration of my child being permitted to attend and participate in the Colonial Classic: Hope for the Cure Tournament, my child and I; and anyone else entitled to act on my child’s behalf, waive and release Robert Morris University Staff, 3 Rivers Lacrosse and Staff, Katy Phillips, Bruce Phillips, and all associated officers, directors, Trustees, employees, servants, or agents and any clinic official; all sponsors; and the successors or representatives of any of the forgoing, from all claims or, liabilities, losses or damages on account of injury or any form of harm, including but not limited to, disability or death which might occur or that may in any way be related to or arise out of participating of any kind arising out of my child’s participation in this event.
By checking the electronic agreement box within the 2018 Colonial Classic Player Registration, you are agreeing that you have read, understand, and acknowledge the parameters of this consent and waiver.
Colonial Classic: Hope for the Cure Tournament MEDICAL TREATMENT CONSENT & WAIVER
I, the legal guardian of the registered player, authorize the Robert Morris University Staff to seek medical treatment for the player as they see necessary. I consent to an x-ray, anesthetic, medical or surgical diagnosis or medical treatment and hospital care subsequently deemed necessary by a licensed health care provider including but not limited to physicians, physical therapists, and athletic trainers during the player’s session. I understand that this authorization is given in advance of any specific diagnosis, treatment, or hospital care, and that it is given to provide the staff authority to seek medical treatment and to provide a licensed health care provider the authority to administer this treatment as they judge necessary to the above named child. I accept responsibility for payment of all services rendered; I authorize any medical facility, which renders services to release medical information necessary for the processing of insurance claims; and I authorize the payment of insurance claims directly to the medical facility. I understand that whenever possible, the Robert Morris University Staff will make a good faith effort to contact me at the phone number listed on the player registration form before seeking treatment. If this is not possible, I understand that the Robert Morris University Staff will notify me as soon as possible of any and all diagnoses and treatments.
Having read this waiver and knowing these facts and in consideration of my child being permitted to attend and participate in the Colonial Classic: Hope for the Cure Tournament, my child and I; and anyone else entitled to act on my child’s behalf, waive and release Robert Morris University Staff, 3 Rivers Lacrosse and Staff, Katy Phillips, Bruce Phillips, and all associated officers, directors, Trustees, employees, servants, or agents and any clinic official; all sponsors; and the successors or representatives of any of the forgoing, from all claims or, liabilities, losses or damages on account of injury or any form of harm, including but not limited to, disability or death which might occur or that may in any way be related to or arise out of participating of any kind arising out of my child’s participation in this event.
By checking the electronic agreement box within the 2018 Colonial Classic Player Registration, you are agreeing that you have read, understand, and acknowledge the parameters of this consent and waiver.