It's no day at the beach, but it's Paradise

Medical Form

Please Print page and bring it with you to the first day of session/camp with all information filled out

 Players name

 Male or Female

 Street Address

 Home Phone

 Date of Birth

 Current Team

 Emergency Contact & Phone number

 Medical Insurance Co.

 Policy #

 Family Physican

 Physican’s Phone #

Recognizing the possibility of physical injury associated with the sport of soccer, I hereby release, discharge, and/or otherwise indemnify Matt Paradise, its ownership, staff, affiliates and associated personnel, including the owners of facilities utilized by the camp against any claim made by or on behalf of the player listed above as a result of the players’s participation in camp activities.  I certify that the player above is in sound physical condition and capable of participating in soccer activities and that there are no medical conditions that would prevent his/her participation or be affected or influenced by the above named player’s participation in soccer activities conducted by Matt Paradise.  In case of emergency, I authorize treatment to be given by my family physician or the nearest Hospital’s emergency department.  I permit Matt Paradise and staff to act on my behalf in accordance with their best judgment in any emergency requiring medical attention.

Parents Signature: ________________________________________________________

Advertisements

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out /  Change )

Google+ photo

You are commenting using your Google+ account. Log Out /  Change )

Twitter picture

You are commenting using your Twitter account. Log Out /  Change )

Facebook photo

You are commenting using your Facebook account. Log Out /  Change )

Connecting to %s