Soccer Informed Consent Form printable pdf download

INFORMED CONSENT FORM RE: SOCCER

Student Name: ______________________________________

Birth Date: __________

School: ____________________________________________

Grade: _____________

We accept and understand that the sport of soccer involves certain inherent risks, dangers and

hazards that may cause serious personal injury, including death, severe paralysis or brain injury

necessitating long term care and significantly impairing enjoyment of life or life activities. We

accept and understand that the above-described injuries and other injuries, including but not

limited to: concussions; serious neck and spinal injuries potentially resulting in complete or

partial paralysis; brain damage; blindness; serious injury to all internal organs; serious injury to

all bones, joints, ligaments, muscles and tendons; contusions; dislocations; sprains; strains; and

fractures, may occur as a result of participating in this sport. We accept and understand that

certain activities such as slide tackling and heading the ball carry with them a greater inherent

risk of injury.

We understand that the inherent risks of this sport cannot be eliminated without jeopardizing the

essential qualities of the sport. We have reviewed all of these risks and we understand and

appreciate them and still desire to participate in the activity.

(Student Initial)________ (Parent Initial)________

We certify that (Student Name) __________________________________has no medical or

physical conditions which could interfere with or compromise his/her safety in participating in

this activity.

(Student Initial)________ (Parent Initial)________

I authorize qualified emergency medical professionals to examine, and in the event of an injury

or serious illness, to administer emergency medical care to the above-named student.

(Parent Initial)________

In the event it becomes necessary for school district staff to obtain emergency medical care for

the above-named student, we understand that neither the staff member nor the school district

assumes financial liability for the expenses incurred because of the accident, injury, illness

and/or unforeseen circumstances.

(Student Initial)________ (Parent Initial)________

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Soccer Informed Consent Form