As a parent and /or guardian, I do authorize the treatment by a qualified and licensed medical doctor of the following person in the event of a medical emergency which, in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment or undue discomfort if delayed. I also authorize Carolina Nation staff to remain with my child in such case of an emergency and for any/all medical information to be disclosed to a Carolina Nation staff member. I hereby accept responsibility for payment of any emergency transportation or treatment on behalf of the player. I further clarify the player is in good physical condition, and has no medical or physical condition that would restrict his/her participation. I hereby agree release and hold harmless Carolina Nation and its staff from and against any and all liability for loss, damages, claims or actions (including costs and attorney fees) for bodily injury and/or property damage, to the extent permissible by law, suffered by me and/ or my child arising from his/her participation in this program. LIST ANY ALLERGIES, CONDITIONS OR RESTRICTIONS BELOW: (PUT N/A FOR NONE) *