In consideration of my/our child's acceptance into the Indiana Fencing Academy/Escrime Du Lac Fencing Camps, I/we as parents and/or legal guardians of
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(name)
do hereby agree to waive all liability of the Indiana Fencing Academy, its staff, and physicians, for any accident, injury, illness, or other mishap that might befall the above-named camper while traveling to or from, or during attendance at the Indiana Fencing Academy/Escrime Du Lac Fencing Camps. Further, I/we hereby grant permission to the staff and physicians of the Indiana Fencing Academy/Escrime Du Lac, to any medical or surgical consultant deemed advisable, and any hospital to render the above-named camper any medical and surgical treatment that they deem necessary. I/we understand that all possible effort will be made to inform me/us in case of such treatment.
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(day phone)
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(evening phone)
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(insurance company)
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(policy number)
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(name of insured)