Coachdbuk Football Consent Form

Coachdbuk Sports Academy

Football Consent Form
PLAYER INFORMATION
Full Name:

First NameLast Name
Address:

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Birth Date:

MonthDayYear
Gender:
T-Shirt Size:
School Class and Year Group:
I authorize that Coachdbuk Ltd to use my child's image/video footage in official media, including: Our website, promo material, newsletters and related media ONLY.
PARENT/GUARDIAN #1
Full Name:

First NameLast Name
E-mail:
example@example.com
Mobile Phone:
Format: (000) 000-0000.
Can you accept text messages?
EMERGENCY CONTACT INFORMATION
Full Name:

First NameLast Name
Relationship to Player:
Mobile Phone:
Format: (000) 000-0000.
WAIVER INFORMATION
I hereby grant permission to allow my child to participate in activities (i.e. football, fitness and athletic training) as provided by the Coachdbuk. Furthermore, I hereby release Coachdbuk, it’s officers, trainers, coaches from any legal or financial responsibility resulting from actions of, or injury to my child while engaged in any or all of these sponsored activities (i.e. training, games, competitions). It is my understanding that every registered participant will be covered by accident insurance.I also certify that my child has NO HEALTH OR PHYSICAL IMPAIRMENTS which will hamper his/her ability to perform as a player or cause his/her participation to be unsafe to themselves or other participants. If there are any health/physical problems Coachdbuk should be aware of please indicate below:
Health/Physical Limitations (if any):
I/We agree with the above
Signature
Should be Empty:

Coachdbuk Sports Academy

PLAYER INFORMATION

PARENT/GUARDIAN #1

EMERGENCY CONTACT INFORMATION

WAIVER INFORMATION