**Required only if directed by staff - all applications include Waiver Form**

MEDICAL INFORMATION
Applicant’s Name:_____________________________
MEDICAL TREATMENT AUTHORIZATION
I/We being the legal guardian(s) of the above applicant, authorize the Navy Rowing Camp For Girls and its agents permission to request medical treatment as necessary to insure the well being of the applicant.
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(Parent or Guardian Signature)
INSURANCE: Coverage for accidental injury is required by all participants. Please complete the health care information below:
HEALTH INSURANCE CARRIER:_____________________________
POLICY NUMBER:____________________________
I approve of my child’s attendance at the Navy Rowing Camp For Girls and certify that she is in good health and able to participate in the program activities. I (am/am not) attaching a statement explaining special physical limitations and/or required medication. Please indicate if your child suffers from allergies, asthma, diabetes, restricted activities, etc. In further consideration of the Navy Rowing Camp For Girls accepting this application, I/we hereby agree to save and indemnify and keep harmless the Navy Rowing Camp For Girls, its agents, and employees against any and all liability, claims, judgments or demands for damages arising as a result of injuries sustained by the applicant during or as a result of any course given the applicant of the Navy Rowing Camp For Girls.
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(Parent or Guardian Signature)