SCENIC ROUTE SPORTS MEDICAL RELEASE FORM PARENTS INFORMATIONFATHERS NAMEFATHER'S EMPLOYERFATHER'S HOME PHONEFATHER'S CELL PHONEFATHERS EMAIL ADDRESSMOTHERS NAMEMOTHERS EMPLOYERMOTHER'S HOME PHONEMOTHER'S CELL PHONEMOTHER'S EMAIL ADDRESSATHLETE INFORMATIONATHLETE NAMEATHLETE AGEATHLETE GENDERATHLETE BIRHDATEATHLETES STREET ADDRESSAPARTMENT, SUITE, ETC.CITYSTATEPOSTAL CODEInsurance InformationIf you have more than one athlete and all have the same inurcance you only have to enter it once. If each athlete has different insurance enter for each athlete.MEDICAL INSURANCE COMPANYINSURANCE COMPANY PHONE NUMBERPOLICY NUMBERINSURANCE GROUP NUMBERMedical ConditionsIf any of the following conditions pertain to the athlete, please indicate that by checking the box ad provide any pertinent additional information in the space below.AllergiesHerniaEye ProblemsEar ProblemsSkin ProblemsStomach ProblemsHeart ProblemsKidney/Urinary ProblemsDiabetesArthritisSensitive to MedicationsRecent InjuriesAsthma/Lung ProblemsCurrent MedicationsADD/ADHDOtherIf you selected other or need to give us any additional medical information please add that here.ACKNOWLEDGEMENT AND SIGNATUREIf, in the event that this athlete should need immediate medical treatment due to any injury or sickness, I do hereby request, authorize, and consent to such treatment as deemed necessary. I also agree to indemnify and save Scenic Route Sports and any representative from any claim related to such treatment. Further, I will pay any amounts not covered by my medical insurance carrier/provider and will not hold Scenic Route Sports responsible for the balance of any related medical bill.I/we understand that Scenic Route Sports does not furnish insurance coverage of any kind or nature, for anyone, for any reason. I/we hereby release, agree to defend, and hold harmless Scenic Route Sports and all of it's affiliates, agents, and associates from any liability whatsoever that may arise pertaining to me and my family, from any cause or reason of all kinds of nature. I/we understand the meaning of liability release to its fullest extent, and agree to the same without reservation or exception.I agree to the terms of the liability waiver *AgreeELECTRONIC SIGNATUREBy signing this you are agreeing the the above terms. The form is collecting your ip address and timestamp of submission.Complete