PROVISION ON MEDICAL RELEASE AND
ADEQUATE INSURANCE COVERAGE
By initialing below, I certify that I have adequate insurance to cover any injury or damage that I may cause or suffer while participating, or else agree to bear the costs of such injury or damage myself.
Initials (to certify the above):
Medical Insurance Carrier:
Name of Medical Physician:
Insurance Co Phone #:
Medical Physician Phone #:
I authorize Cheer Honolulu or any of its coaches, captains, managers, Board of Directors, employees, volunteers, contractors, or agents to make decisions regarding medical care in case of emergency. I agree to pay all costs associated with such care and related transportation.