Medical & Liability Consent Form
Release and Medical Authorization
This is to certify that the participant has been examined by a physician within the past year, and that he was found to be physically able to participate in vigorous physical activity and competitive athletic sport.
Release of Liability and Medical and Surgical Authorization
In consideration of being permitted to participate in the 2026 Chew Dawg Hockey Academy camp, I hereby assume the risks of personal injury that result from program activities. I am knowledgeable about the sport, have previously participated in the sport, and am aware of the potential for injury while participating. Chew Dawg Hockey Academy will not be responsible for personal injury that results from negligent acts or omissions of the program employees. As a participant and/or parent or guardian, I do hereby release employees from all liability for personal injury or property damage that results from causes beyond the control of, and without the fault or negligence of employees.
I hereby authorize and give my consent to the health care providers to perform upon or administer to the participant any reasonable, necessary, surgical, or medical treatment. I also give permission to administer whatever anesthetic may be necessary or advisable during the medical or surgical procedures. This authorization is intended to cover emergency treatment, immunizations, injections, and minor operations and procedures.
I understand that Chew Dawg Hockey Academy offers an excess insurance for injuries as a result of this and that all claims must first be filled with my primary insurance in order to be eligible for this excess coverage. I authorize my insurance company to pay benefits to the healthcare providers that program employees send to for evaluation and treatment. I authorize the disclosure of medical information to my insurance company and to Chew Dawg Hockey Academy excess carrier for the purpose of a claim. This permission is valid only while the participant is attending the 2026 camp by Chew Dawg Hockey Academy.
