National Sports Center for the Disabled - outdoor recreation opportunities for individuals with disabilities

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Advisory Board

Date: May 6, 2008
Time: 6:00pm-7:45pm
Location: Swope Park, E. 63rd St. & Lewis Rd., Kansas City, MO 64130

5:45 - 6:00pm	Registration & Check In
6:00- 7:30pm	Skills Clinic
7:30 - 7:45pm	Snacks & Giveaways

AbilityCAMP Registration Form
AbilityCAMP:	* required
Participant First Name:	*
Participant Last Name:	*
Parent/Guardian Name:	*
Address:	*
City:	*
State:	*
Zip Code:	*
Phone:	*
Email Address:	*
Age:	*
Date of Birth:	*
Sex:	Male Female *
Disabilities:	*
Seizures:	Yes No *
Medications:	*
Wheelchair:	Manual Power
Sign Language Interpreter?	Yes No *
Emergency Contact:	*
Emergency Contact Phone:	*

AbilityCAMP Participant Waiver of Liability
In consideration of my child (participant) being permitted to participate in the Chiefs AbilityCAMP offered by the National Sports Center for the Disabled, Kansas City Chiefs Football Club and the City and County of Kansas City Department of Parks and Recreation, on behalf of my child, myself, and anyone who obtains rights from my child or me, I hereby voluntarily waive, fully release and discharge any of the above mentioned agencies and entities, their directors, officers, employees, agents, insurers, various sponsors and paid and non-paid volunteers from liability for injury, illness, death, damage or loss to participant or participant's property arising out of or in any way related to Participant's activities at the Chiefs AbilityCAMP. I understand that the staff/volunteers of this camp are not allowed to administer medication or provide personal care such as feeding, toileting, and/or dressing. Anyone needing this type of assistance must make their own arrangements. I have read this form and understand its content and request registration for my child.
Agree:	Yes No *
Photo Release

I grant permission for Participant's picture to be used in publicity or brochures related to this event.
Agree:	Yes No *
Participant Name:	*
Parent/Guardian Signature:	*
Date:	*
Sign here:	__________________________
Please print this page out and bring it to the camp with you.

P.O. Box 1290, Winter Park, Colorado 80482 USA phone: 970.726.1540 or 303.316.1540 Fax 970.726.4112
Denver Office: 1801 Bryant St, Ste 1500, Denver, CO 80204 ph: 303.293.5711 fx: 303.293.5448 Email: info@nscd.org

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