The Manchester Youth Strings
String Camp 2015
June 22-26

Manchester Youth Strings Camp Health Form

MEDICAL & LIABILITY RELEASE: My signature below authorizes the MYS and its associates to secure proper medical attention and/or hospitalization of the musician described on this form in the event of a medical emergency. I assume responsibility for payment of such treatment and authorize the billing of my insurance company. I have provided the applicable medical insurance information above. I expect every effort will be made to contact me prior to such action and, if this is not possible, I will be notified as soon as possible. I hereby release the MYS and its associates from all liability while the aforementioned musician partakes in the current MYS String Camp are program. MYS String Camp is an activity that provides a learning experience for the musicians and allows them an opportunity to apply their musical knowledge. Although I understand that MYS will make reasonable efforts to provide a safe environment, I am fully aware of the risks inherent in participating in this activity. Being fully aware of the risks, I hereby give my consent for the musician described on this form to participate in this activity and release the MYS and its associates from any and all liability associated with this activity.

In addition to the medical and liability release, our signatures below indicate that we have read and agree to comply with all of the above.

** Please read, sign, and date this document in its entirety. *


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604 E. College Ave.
North Manchester, IN 46962