get these forms and fill them out

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get these forms and fill them out
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Dunedin Stirling Soccer Club Medicat Release Form
(Parent/Guardian) hereby give
i.
permission for any and all medical attention to be administered to m)''
(Child's name) in the event of accident. injury"
child
sickness, etc., under the direction of the person(s) listed below, until such time as I ma5'
be contacted. I also assurne the responsibiiiti, for the payment of any such treatment. This
release is effective for the period of one year from tire date given below.
Parent(s) Name
Address
Citt
State
Home Phone
Zip Cade
Alt. Phone
lnsurance Carrier
Subscriber
Policy #
Grcup #
In case I cannot be reached, any of the following persons is designated to act on my
behaH:
o Coach
o Asst. Coach
o
o
Manager
A league representative where my child is playing
Any toumament representative where my child is participating in a tournament'
Child's Physician
Address
Phone #
Signature of Parent/Guardian
Known allergies
Date