Roane State Community College

Camp Application

Participant Name

Primary Position

Secondary Position

Address

City

State

Zip

Phone

Email

Age

High School

High School Graduation Year

Parent's Name

In case of emergency, notify

WAIVER AND RELEASE: In consideration of my application being accepted, I intending to be legally bound, do hereby for myself, heirs, executors and administrators, waiver, release, and forever discharge any anal all rights for damages which I may have or which may hereafter accrue to me against Roane State Community College, the Roane State Athletics Department, Roane State Softball Camps, Jessica Hackworth, or their respective employees, officers, agents, representatives, successors and/or assigns, for any and all damages which may be sustained or suffered by my in connection with my association with or participation in or rising out of my traveling to and returning from said school to be participate in on the campus of Roane State Community College.

Participant’s Signature (Type)

Parent’s Signature (Type)

Date