Thank you for signing up for the Erik Nates Euro Hockey Summer Camp. Please fill out the Medical Release form below to complete your order. General InformationStudent Name* First Last Date of Birth* MM DD YYYY Address* Street Address Address Line 2 City State AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific ZIP Code Home PhoneEmail Work PhoneCell PhoneEmergency Contact InformationName First Last RelationshipPhoneHealth HistoryAllergies (include Food & Medications)* None Yes. Please List List AllergiesGeneral Health History (Include asthma, ADHD, concussions etc.)* None Yes. Please List List Health HistoryAuthorization for Medical Care* I agree I hereby consent that in the event of an injury to my child to allow examination by a qualified person and to allow medical treatment and or medication needed after examination by a qualified doctor or hospital.Date This medical release is relative to Scheduled Erik Nates Euro Hockey activities in the event the parent(s)/ guardian are not present to assure medical treatment if necessary. If the camper or staff member needs a prescribed medication during the camp, the following must be completed three weeks before the first day of camp: The administration of medication will only be completed with a written authorization signed by parent or legal guardian.