3v3 Player Waiver/ Medical Release Form
Each PLAYER on roster must fill out below form
Name
*
First Name
Last Name
Email
*
example@example.com
Team Name & Age Group:
*
example: Vipers-Boys U11
Player's Birthdate:
*
I agree to:
*
Medical Release FormI hereby give permission for any and all medical attention necessary to be administered to my child, whose name appears below, in the event of an accident, injury, sickness, etc. under the direction of the person(s) listed below, until such time as I may be contacted. This release is effective until revoked by me. I also hereby assume the responsibility for payment for such treatment.
Parent/Guardian Full Name:
*
Medical Insurance & Policy Number:
*
Phone Number
*
Emergency Phone Number
*
Release of Liability
Signature
*
Submit
Should be Empty: