Home of Youth Rowing
In tallahassee, florida
I, the parent(s) or legal guardian(s) of the rower named above (hereinafter “child/ward”) do hereby authorize Capital City Rowing (“CCR”) and its officers, directors, coaches or parent chaperones (collectively “Authorized Persons”) to transport my child/ward to regattas and other sporting events located anywhere in the United States and, to the extent any medical emergency should arise, also authorize and direct any of the Authorized Persons to act as my agent in (i) transporting my child/ward to any medical treatment facility deemed appropriate in the opinion of the Authorized Person (or to arrange for the transport of my child/ward by any public or private ambulance service), or (ii) consenting to any x-ray, examination, anesthetic, medical or surgical treatment and hospital care which is deemed advisable by, and is tendered under the general and special supervision of, any physician, surgeon, nurse, paramedic or EMT licensed to provide medical care in the jurisdiction.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care that might be required and is given to provide authority and power to the aforementioned Authorized Persons and medical care providers in the exercise of his or her best judgment that may be deemed advisable. Medical and insurance information is provided on the reverse side of this form and any Authorized Persons or medical care providers may rely upon the accuracy and completeness of that information. I understand that I retain full financial responsibility for any care rendered to my child/ward, and that the accompanying sponsor has no financial responsibility for any emergency care rendered under this authorization. I also agree to indemnify and hold CCR and any Authorized Person harmless for any claims or damages arising from the exercise of this Travel and Medical Release.
It is understood that my child is required to comply with all rules of conduct and is subject to the consequences for violations of the rules set forth in the Capital City Rowing Handbook while attending all rowing functions. It is understood that violations of any of these rules, or other violations of the Capital City Rowing Code of Conduct, may subject my child to discipline, including not being able to participate in Regattas or being returned home at the Parents expense from a regatta prior to the conclusion of the regatta, at the discretion of the chaperones and coaches.
I certify that I am the parent or legal guardian for my child(ren). I hereby give my permission for any supervisor, coach or other team administrator associated with the Capital City Rowing to seek and give appropriate medical attention for our child(ren) in the event of accident, injury, illness. I will be responsible for any and all costs associated with any necessary medical attention and/or treatment.
I hereby waive, release and forever discharge Capital City Rowing and associated supervisor, coach or other team administrator from all rights and claims for damages, injury, loss to person or property which may be sustained or occur during participation in Capital City Rowing activities, whether or not damages or loss is due to negligence. I hereby acknowledge that my children is (are) physically fit and capable of participation in all Crew Team activities.
Copyright 2020, Capital City Rowing, Inc. 1400 Village Square Blvd. #3-310, Tallahassee, FL 32309
Capital City Rowing, Inc is a 501(c)3 non-profit organization.