Elementary Christian Conference    
Emergency Information & Medical Waiver

While benefits derived from athletic participation are great, there are also calculated risks involved in such competition. Both participants and parents are hereby advised that an element of risk is present that could result in physical injury, total paralysis or death in such participation. In the event that an injury arises, I (parent or guardian) understand that medical expenses are to be my responsibility and I hereby submit necessary insurance information to be used incase of an emergency. Being fully aware of the hazards and possible consequences involved, and being legally competent to give consent, I (parent or guardian) hereby consent and further agree to hold the Elementary Christian Conference and its employees, agents, participating schools and professional staff , school, gym or athletic facility, harmless from and against any and all demands, damages, cost expenses or liabilities resulting from or incurred because of my child's participation as a player or spectator in the athletic events sponsored by the Elementary Christian Conference.

Athlete's School_________________________________________

Athlete's Name __________________________Coach's Name_________________________

ECC    Division:    Girls A______, Girls B _____, Boys A______, Boys B______, Boys C ________

Parent or Guardian Name____________________________________________ Please Print

Parent or Guardian's Signature:______________________________________

Athlete's Social Security# (Optional)______________________ Date of Birth_____

Home Address___________________________________ City_______________

Home Phone ____________________________Work Phone__________________

Cell Phone or pager#_______________________________________________

Other person to contact if parents are not available_______________________

Relation_____________________________ Phone #________________________

Coaches: Send this completed form with your team's roster to: Al Cap 10612 E 99th Tulsa 74133 
                or fax# 317-5157.  If you have any questions email me @ allencap6@cox.net.