Home > Life > Medical Forms > Medical Release Template > California Medical Release Form > California Player Medical Release Template

California Player Medical Release Form

At Speedy Template, You can download California Player Medical Release Form . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.
This form is provided by Vista Soccer Club for it's players medical release.

California Player Medical Release Form
California Player Medical Release Form
P.O. Box 2322, Vista, CA 92085
Tel (760) 940-8804 Fax (760) 940-8997
www.vistasocerclub.org
VISTA SOCCER CLUB
PLAYER INFORMATION & MEDICAL RELEASE FORM
Players Name _______________________________________ Birthdate ____/____/____ Gender M / F
Home Phone __________________ Cell Phone __________________ Work Phone _________________
Parent(s) Name(s) __________________________ Email Address _______________________________
Address ___________________________________________ City __________________ Zip __________
I/We, the parent/guardian of the player named above (a minor), and the player agree to:
(1) Abide by the rules of Cal South, its affiliated organizations, and sponsors. Recognizing the possibility
of physical injury associated with soccer and in consideration for Cal South accepting the registrant for
its soccer programs and activities (“Programs”), I hereby release, discharge, and/or otherwise indemnify
Cal South, 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.
(2) Hereby 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 dependent.
___________________________________ _______________ __________________________
Signature of Parent/Guardian Date Emergency Phone Number
Insurance Company ______________________________ Policy Number _________________________
Known allergies or other pertinent medical information ________________________________
_____________________________________________________________________________
Emergency Contract (other than parent/guardian)
___________________________________ _______________ __________________________
Print Name of Emergency Contact Relation Phone Number
California Player Medical Release Form

Relevant Download