NHSA National Championship Lodging Form

Family Name

First Name

Last Name

Cell Phone #

(###)

###

####

# of adults staying on LBCR campus

# of children over 5 staying on campus

# of children under 6 and under staying on campus

# of player/auxiliary students staying on LBCR campus

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

List any medication / medical treatments player is taking:

Is Player allergic to any medication?

Date of last Tetnus Shot

YYYY

You Insurance Company Name & Policy #

Parents/Guardian Release of Liability:

I/We, the undersigned, hereby certify that, by selecting "YES", I am the parent or legal guardian of the player. I hereby give permission for the staff of the NHSATournament to seek medical attention for the player if it is deemed necessary during the NHSA Tournament. I will be responsible for any and all costs of medical attention and treatment. I/We, the undersigned, for ourselves, our heirs, our executors & administrators, waive, release and forever discharge the NHSF Tournament, its staff, agents, employees and administrators from any liability due to personal injury, death or loss.