Medical Release Form for Tournament

 
 TOWN OF POUGHKEEPSIE SOCCER CLUB

COLUMBUS WEEKEND SOCCER TOURNAMENT


Medical Release



I , the parent/guardian of the registrant, a minor, agree that I and the registrant will abide by the rules of the Unites States Youth
Soccer Association (USYSA), its affiliated organizations and sponsors. Recognizing the possibility of physical injury associated with
soccer and in consideration for the USYSA accepting the registrant for its soccer programs and activities (“The Programs”). I hereby
release, discharge and/or otherwise indemnify the USYSA, its affiliated organizations and sponsors, their employees and associated
personnel, including the owners of fields 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.

Medical Consent

As the parent or legal guardian of the registrant, I herby give my consent for emergency medical care prescribed by a duly licensed
Doctor of Medicine or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve the life, limb
or well being of my dependant.


Parent Signature_________________________________________________

Please print name ________________________________________________

Date __________________

POUGHKEEPSIE SOCCER CLUB