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Consent for
Emergency Medical Aid and Medical Treatment
As the registrant or Parent/Legal Guardian
of the above named registrant, I hereby give consent
for emergency medical care prescribed by a duly
licensed Doctor of Medicine or Doctor of Dental
Medicine. This care may be given under whatever
conditions are necessary to preserve life, limb, or
well-being as deemed advisable in the event of an
accident or illness during the soccer related
activities in which we are voluntarily
participating. I , the participant or
parent/guardian of a minor registrant, agree that
the registrant and I will abide by the rules of the
league, its affiliates and sponsors. Recognizing the
possibility of physical injury associated with
Soccer & Futsal and in consideration for the League
accepting the registrant for its Futsal and
Soccer programs and activities (the "Programs"), I
hereby release, discharge, and/or indemnify the
League, its affiliated organizations (if any) and
sponsors, their employees and associated personnel,
including the owners of gymnasiums and facilities
utilized for the Programs, against any claim by or
on behalf of the registrant as a result of the
registrant's participation in the Programs and/or
being transported to or from the same, which
transportation I hereby authorize. Further, I hereby
acknowledge that participation in athletic
competitions, camps, and/or clinics carries with it
certain potential hazards. In consideration for
League accepting the registrant for its program,
I further release, discharge and/or indemnify the
club, its officers, directors and employees, any
coaches, assistant coaches a nd
referees, the facilities in which any such athletic
activities are being physically conducted, the
league with which I am affiliated, the organization
permitting the
institution/facility, and the institution/facility
at which this activity is being conducted, against
any claim by or on behalf of the registrant as a
result of registrant's participation
in the Futsal and Soccer
programs.
Parent / Legal Guardian Name:
Parent / Legal Guardian Signature:
(if signing up
online please type in name and last 4 digits of your
social security number)
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