2013 Gremlins 3v3 Tournament
Player Registration & Medical Release Form
Each coach must have a copy of this form in his/her possession on the field for each player!!!
REGISTRATION SECTION:
Player Name: _____________________________________ Home Phone: __________________________
Team Name: __________________________________ Coach Name: ______________________________
Address, City, State: ______________________________________________________________________
Date of Birth (month/day/year): _______________ Age: ________ Gender: _______
MEDICAL RELEASE SECTION:
This is to certify that my son/daughter ___________________________has my permission to participate in the Gremlins 3v3 Soccer tournament. I recognize there are inherent risks, dangers, and hazards associated with participating or spectating in the sport of soccer which can result in serious personal injury, loss or death. I hereby, for myself and any player for whom I am a parent or legal guardian release, hold harmless and forever acquit the Gremlins Soccer Tournament officers, agents, representatives, trainers, volunteers and employees from any and all actions, causes of action, claims or any liabilities whatsoever, known or unknown now existing or which may arise in the future, on account of or in any way related to or arising out of my son/daughter's participation in the tournament. Further, I assume all liability of any non-participants who accompany me to the games. In the event of injury or illness to my son/daughter, I hereby grant authority to a qualified physician to render such medical treatment as he/she deems necessary under the circumstances.
My son/daughter has the following medical conditions: __________________________________________________________________________.
My son/daughter has the following allergies: __________________________________________________________________________________.
Medical Insurance Co. __________________________________ Policy Number _____________________________________________
Name of Policy Holder _____________________________________
In case of emergency, I can be reached at the following number(s):
_________________________________ (home) ___________________________________ (cell)
Should you be unable to reach me, you may contact:
Name: ______________________________________ Phone:__________________________ Relationship: ___________________________
Parent/Guardian Signature ______________________________________________________
Printed Name ___________________________________________ Date: _____________________
Each coach must have a copy of this form in his/her possession on the field for each player!!!
REGISTRATION SECTION:
Player Name: _____________________________________ Home Phone: __________________________
Team Name: __________________________________ Coach Name: ______________________________
Address, City, State: ______________________________________________________________________
Date of Birth (month/day/year): _______________ Age: ________ Gender: _______
MEDICAL RELEASE SECTION:
This is to certify that my son/daughter ___________________________has my permission to participate in the Gremlins 3v3 Soccer tournament. I recognize there are inherent risks, dangers, and hazards associated with participating or spectating in the sport of soccer which can result in serious personal injury, loss or death. I hereby, for myself and any player for whom I am a parent or legal guardian release, hold harmless and forever acquit the Gremlins Soccer Tournament officers, agents, representatives, trainers, volunteers and employees from any and all actions, causes of action, claims or any liabilities whatsoever, known or unknown now existing or which may arise in the future, on account of or in any way related to or arising out of my son/daughter's participation in the tournament. Further, I assume all liability of any non-participants who accompany me to the games. In the event of injury or illness to my son/daughter, I hereby grant authority to a qualified physician to render such medical treatment as he/she deems necessary under the circumstances.
My son/daughter has the following medical conditions: __________________________________________________________________________.
My son/daughter has the following allergies: __________________________________________________________________________________.
Medical Insurance Co. __________________________________ Policy Number _____________________________________________
Name of Policy Holder _____________________________________
In case of emergency, I can be reached at the following number(s):
_________________________________ (home) ___________________________________ (cell)
Should you be unable to reach me, you may contact:
Name: ______________________________________ Phone:__________________________ Relationship: ___________________________
Parent/Guardian Signature ______________________________________________________
Printed Name ___________________________________________ Date: _____________________
