Medical Authorization

Childs Name

Parents Name

Email Address

Phone

I grant permission to my child to use all equipment and participate in all activities at Hampton Racquet I grant permission to my child to use all equipment and participate in all activities at Hampton Racquet Yes No

I grant my child permission to use the swimming pool under supervision I grant my child permission to use the swimming pool under supervision Yes No

I grant permission for sunscreen to be reapplied by Hampton Racquet staff members I grant permission for sunscreen to be reapplied by Hampton Racquet staff members Yes No

I grant permission for my child to leave the premises under supervision by staff for offsite field trips I grant permission for my child to leave the premises under supervision by staff for offsite field trips Yes No

I grant permission for my child to be included in photographs, videos and electronic newsletters used at Hampton Racquet. I grant permission for my child to be included in photographs, videos and electronic newsletters used at Hampton Racquet. Yes No

In case of an accident or injury, I authorize any and all emergency medical, dental, and/or surgical care and hospitalization advised by the physicians, surgeon, or hospital necessary for the proper health and well-being of my child In case of an accident or injury, I authorize any and all emergency medical, dental, and/or surgical care and hospitalization advised by the physicians, surgeon, or hospital necessary for the proper health and well-being of my child Yes No

Does your child have any medical conditions that Hampton Racquet staff should be aware of?

Hampton Racquet is not AUTHORIZED to administer medication. Does your child take any medication that we need to be aware of?

Please list the name of people that are allowed to pick up your child