PARENT/GUARDIAN CONSENT AND PLAYER MEDICAL RELEASE FORM

Player's Full Name*

Parent's Full Name*

Date of Birth*

Gender*

Address*

Parent's Email*

Parent's Contact Number*

Emergency Contact Name*

Emergency Contact Number*

Does your child have any medical conditions our staff may need to be aware of?*

No

Yes

If yes, kindly list/explain:

List any medical equipment the staff may need to have on hand in support of your child:

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