NOT TO BE USED FOR YOUTH TEAM SPORT PARTICIPATION

Participant's Name:     Activity/Program:  

Email Address:  

Address:  

Date of Birth:  

Age:  

Male / Female:  

Phone #:  

Optional Participant's Insurance: $7.00 child      $14.00 adult  

I hereby give my permission to participate and be involved in Onslow County Department of Recreation programs.  By this authorization, I hereby approve of the program and accept the facilities, equipment, supervision, and the instruction, and the instructor/coach as being satisfactory for the above named person.  I have been given the opportunity to inspect the premises and equipment and have talked with the instructor/coach or waive the right to do so.  I understand that immediately prior to any activity involved in the program named herein above, I have the right to inspect the facilities or equipment and will notify the instructor or supervisor or the County of any objections to the supervision, instruction, facilities, or equipment used in connection therewith.  I hereby release and hold harmless the County of Onslow, the Onslow County Parks and Recreation Department, and any of their agents or representatives from and against any and all claims and liability and causes of action at law for loss, damage, or injury (including death) to persons and/or property which would or could be based on the qualification of the instructor/coach of the adequacy of the supervision, facilities, or equipment used in the program named above.

AUTHORIZATION FOR MEDICAL ATTENTION
I hereby give the assigned coach/instructor or authorized personnel permission to seek appropiate medical care as may be deemed necessary in the event of injury/illness to my child/participant should I be unavailable to make such decisions.

I have read and accept the waiver: