PARENT
CONSENT FORM
Please print the consent form, complete the form and mail
it along with your application.
| PERSONAL INFORMATION | |
| Guardian Name | _________________________________ |
| Name of Minor | _________________________________ |
| Date of Birth | _________________________________ |
| Allergies | _________________________________ |
| Present Medications | _________________________________ |
| Past Injuries | _________________________________ |
| EMERGENCY CONTACTS | |
| Parent or Guardian | _________________________________ |
| Phone | _________________________________ |
| Additional Emergency Contact | _________________________________ |
| Phone | _________________________________ |
| Your Insurance Company | _________________________________ |
| Policy # | _________________________________ |
| Group # | _________________________________ |
| Phone | _________________________________ |
| MEDICAL RELEASE | |
| Participation in any sport may cause different types of physical injuries. In the event of an injury, I give authorization to a Trainer, Doctor, Nurse or Emergency Personnel to administer first aid or care if needed. I understand the risk of injury and I hereby waive any claims that I might have against HANDS OFF Soccer Camp and its employees and authorized representatives. | |
| Parent/Guardian Signature ______________________________________ | |
| Date ____________________ | |