Medical Release Form -Seattle United Form printable pdf download

AUTHORIZATION TO PLAY, MEDICAL RELEASE, AND WAIVER FORM

With the signature(s) below, permission is hereby granted for ___________________________ (participant) to

participate in all practice sessions, games and other activities involving Seattle Youth Soccer Association

during the ___________ (current year) season. This permission extends to any travel to and from any and all

practice sessions, games and other activities sponsored and arranged by the Seattle Youth Soccer Association.

This permission is granted without reservation. Recognizing the risks presented by the competitive

contact sport of soccer, the signature below indicates a knowing, voluntary release of any claim which might

be asserted against Seattle Youth Soccer Association, its officers, administrative assistants, coaches, assistant

coaches, managers, sponsors, chaperones, designated drivers, volunteers, and any other agents representing

Seattle Youth Soccer Association. By waiving any right to assert a claim, I am agreeing to release, absolve,

indemnify and hold harmless any and all parties previously mentioned for any and all liability arising from any

injuries incurred by participant in the Association. My waiver expressly means that I, participant’s legal parent

or legal guardian, accept and assume all risks and hazards inherent in and related to the activities of Seattle

Youth Soccer Association, including any travel to and from any activities sponsored and arranged by Seattle

Youth Soccer Association.

This permission also includes my authorization for emergency medical treatment deemed appropriate

and necessary by any coach, assistant coach or representative or agent thereof for participant, including

transport to the nearest medical facility adequate to treat the emergency. Participant has the following medical

condition (s):

Mother’s name ________________________ Home Phone ____-______ Work/Cell Phone ____-______

Father’s name _________________________ Home Phone ____-______ Work/Cell Phone ____-______

Physician _________________________________________________Phone _______-______________

Health Insurance Plan _________________________________________________________________

Medical Plan Number _______________________________________________________

I have read this authorization to play, medical release and waiver, acknowledge that I understand it and agree

to be bound by it.

Dated ___________________ Parent/Guardian Signature _____________________________________

Dated _________________

Parent/Guardian Signature _____________________________________

Medical Release Form -Seattle United Form