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Wildcat Hoop School

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Please provide the following medical information required of all non-Norwich Free Academy students who participate in summer programs.

Please list any food or environmental allergies your son/daughter may have.
Allergy MedicationDoes your son/daughter require medication for this allergy?
Does your son/daughter require medication for this allergy?
Please list the allergy medication.
Please list any medication(s) your child is currently taking and the reason for the medication.
Are there special precautions you wish NFA staff to know concerning your child's medical history?
$100.00
July 15-19, 2024

Parent/Guardian Acknowledgment: I certify that I am age 18 or older. I have carefully read and freely sign the Acknowledgment & Assumption of Risk, Release, and Waiver of Liability. I fully understand and agree that this Acknowledgment & Assumption of Risk, Release, and Waiver of Liability is a legally binding agreement, that I on behalf of myself and the Student have given up substantial rights by signing it, that no oral or written statements or representations can or will alter the contents of this document, and that I and Student sign it freely and voluntarily without any inducement or undue influence. I agree that this agreement shall be governed by the laws of the State of Connecticut (excluding its conflict of laws principles), which shall be the forum for any lawsuits filed under or incident to this agreement or the Sports Activities. I further agree that this agreement is intended to be as broad and inclusive as is permissible by the laws of the State of Connecticut and that if any portion of this agreement is held to be invalid, it is agreed that the balance shall, notwithstanding, continue in full force and effect.

Discipline Policy - I understand that this is a summer program at Norwich Free Academy and that regular school rules apply. Although we do not expect any disciplinary issues, please be advised that any student participating is expected to behave properly and follow all directions given by the faculty and administration. Failure to do so may result in the removal from the program.

NFA Public Relations/Student Names and Photos - Norwich Free Academy often uses images/photos of students on our website, social media, promotional materials and advertisements. If you do not want your child’s name and/or picture to appear in any NFA promotional materials, in print or digital form, please email communications@nfaschool.org with your child's name and the program they are attending.

*Norwich Free Academy may call 911 for transport to the nearest hospital in the event of an emergency.

**Student-athletes with Asthma, or an allergy that requires an Epi-pen, must present their medication to the coach and/or instructor, prior to the start of the event each day, in order to participate. 

My signature indicates: That I have read and agree to NFA's terms and conditions regarding the Acknowledgment & Assumption of Risk, Release, and Waiver of Liability, medical emergencies, medication, discipline, and public relations and that the medical information which I have provided is accurate and complete.

Please type your name to sign this document.

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