SayPro Medical Waiver and Consent Form.

SayPro January SCDR.4.3.4 – Development 5-Day Tennis Camp

Participant’s Name: __________________________________
Date of Birth: //____
Age: _______
Gender: __________
Parent/Guardian Name (if participant is a minor): __________________________________
Emergency Contact Name: __________________________________
Emergency Contact Phone Number: __________________________________
Secondary Emergency Contact Name: __________________________________
Secondary Emergency Contact Phone Number: __________________________________

Section 1: Medical Information

To ensure the safety and well-being of all participants, please provide accurate medical details.

1. Does the participant have any existing medical conditions? (Check all that apply)
☐ Asthma
☐ Diabetes
☐ Epilepsy/Seizures
☐ Heart Condition
☐ Allergies (Specify Below)
☐ Other (Specify Below)
Details: ____________________________________________

2. Does the participant have any allergies? (Food, medication, insect bites, etc.)
☐ No
☐ Yes (Specify): ______________________________________________________

3. Is the participant currently taking any medications?
☐ No
☐ Yes (Specify medication and dosage): ______________________________________________________

4. Does the participant have any physical limitations or injuries that may affect their participation in the tennis camp?
☐ No
☐ Yes (Specify): ______________________________________________________

5. Has the participant been hospitalized or undergone surgery in the past year?
☐ No
☐ Yes (Specify): ______________________________________________________

6. Does the participant require any special medical accommodations during the camp?
☐ No
☐ Yes (Specify): ______________________________________________________

Section 2: Medical Treatment Authorization

In the event of a medical emergency, I, the undersigned, authorize SayPro and its representatives to seek medical treatment for the participant listed above. I understand that every effort will be made to contact me or the emergency contacts provided before any treatment is administered.

☐ I agree to the above medical treatment authorization.

Parent/Guardian Signature (if participant is a minor): __________________________________
Date: //____

Participant Signature (if over 18): __________________________________
Date: //____

Section 3: Liability Waiver and Assumption of Risk

I understand that participation in the SayPro 5-Day Tennis Camp involves physical activity that carries the potential for injury. I acknowledge that SayPro and its staff will take necessary precautions to ensure participant safety, but I accept full responsibility for any risks associated with participation.

I, the undersigned, hereby release SayPro, its coaches, staff, and affiliates from any liability for injuries, accidents, or medical conditions that may arise during the camp. I also acknowledge that I am responsible for any medical expenses incurred as a result of participation.

☐ I have read and agree to the liability waiver and assumption of risk statement.

Parent/Guardian Signature (if participant is a minor): __________________________________
Date: //____

Participant Signature (if over 18): __________________________________
Date: //____

Section 4: Consent for Emergency Medical Treatment

In the event that the participant requires emergency medical attention and I am unable to be reached, I authorize SayPro staff to provide first aid and/or secure emergency medical services, including transportation to a medical facility if necessary.

☐ I agree to emergency medical treatment authorization.

Parent/Guardian Signature (if participant is a minor): __________________________________
Date: //____

Participant Signature (if over 18): __________________________________
Date: //____

Section 5: Insurance Information (Optional but Recommended)

Insurance Provider: __________________________________
Policy Number: __________________________________
Primary Care Physician Name: __________________________________
Primary Care Physician Contact: __________________________________

Section 6: Photo & Video Release Consent

SayPro may take photographs and videos during the camp for promotional, educational, or training purposes. Please indicate your preference below:

☐ Yes, I grant SayPro permission to use my/my child’s photos/videos for promotional purposes.
☐ No, I do not consent to the use of photos/videos.

Parent/Guardian Signature (if participant is a minor): __________________________________
Date: //____

Participant Signature (if over 18): __________________________________
Date: //____

Submission & Storage

• This form must be completed, signed, and submitted before the first day of camp.
• Forms can be submitted online via SayPro’s platform or printed and handed in at registration.
• All information will be stored securely and only accessed by authorized SayPro staff.

Conclusion

The SayPro Medical Waiver and Consent Form is a mandatory document that ensures the safety and preparedness of all participants attending the 5-Day Tennis Camp. It provides critical medical information, establishes emergency treatment authorization, and releases SayPro from liability, ensuring a safe and well-managed sporting experience.

Would you like to include additional sections, such as dietary restrictions or additional health considerations?