Waiver and Health History Form (required for Summer Camp)

    ADMINISTRATION OF MEDICATIONS (if applicable)

    IF MEDICATIONS ARE APPLICABLE, PLEASE GIVE DETAILS HERE

    SUNSCREEN AND BUG SPRAY ADMINISTRATION

    WAIVER / INDEMIFICATION

    Parent(s) or legal guardian must sign below before player is accepted to participate in the Brookline /junior Tennis Academy: As parent/legal guardian of the child name herein, I hereby represent that the child has been examined by a pediatrician and is physically fit to participate in the Brookline Tennis Junior Academy. I understand there are inherent risks in participating in this athletic program. I hereby accept responsibility for and agree to pay any and all costs of medical treatment resulting from any injury suffered by my child as a result of his/her participation at the Brookline Tennis Junior Academy. I further agree to indemnify and hold harmless The Roxbury Latin School, Brookline Tennis, its agents, servants, employees and/or representatives from any and all liability, damage, cost or expense arising out of my child's participation, of every kind and nature, at the Brookline Tennis Junior Academy. In the event that I cannot be reached in an emergency, I hereby give permission for care to be administered by a qualified staff member, emergency medical technician, physician/staff of a hospital, or any qualified individual to provide any medical treatment deemed necessary for my child.

    My child's physician's form:
    is attached to this document (attach below)will be mailed to Brookline Tennis Academy