NLS MEDICAL FORM WAIVERMust be filled out before first clinic Clinics What location and clinic will you most frequently be attending? Malibu Pole Vault Malibu Youth Track Redondo Pole Vault Redondo Youth Track El Camino CC Pole Vault El Camino CC Youth Track Guardian Name First Name Last Name Child Name First Name Last Name Date of Birth MM DD YYYY Health Conditions Guardian Email Address Address 1 Address 2 City State/Province Zip/Postal Code Country Phone (###) ### #### Emergency Contact First Name Last Name Emergency Phone Number (###) ### #### Checkbox I have enrolled my child in a program of physical activity. I hereby affirm that he/ she is in good physical condition and does not suffer from any disability that prevents or limits his/her participation in this exercise program. In consideration of my child’s participation in the No Limit Sports program, I hereby release No Limit Sports (employees and owners), Malibu high school and/or Redondo Union H.S., El Camino City College, from any claims, demands and causes of action arising from his/her participation with No Limit Sports. I realize there are physical risks when participating in a program of physical activity and I hereby release No Limit Sports, Malibu high school, and/or Redondo Union High School from any liability now or in the future including, but not limited to, pulls or tears, broken bones, shin splints, heat prostration, knee/lower back/foot injuries and any other illness, soreness or injury however caused, occurring during or after my child’s participation in a No Limit Sports camp or clinic. I have read, understand and accept all policies. I Understand Initial * By initialing here you are signing this form. You are agreeing to the medical waiver and that everything is true and correct. Todays Date * MM DD YYYY USATF # * USATF MEMBERSHIP is required to participate in any NO LIMIT SPORTS Clinics. You can apply on line at http://www.usatf.org/membership/. USATF membership must be renewed annually. Our club number is 198, No Limit Sports Advertising * I authorize No Limit Sports to use pictures of me in their advertising and promotion. yes no Thank you!