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Florida Medical History And Release Form For Player

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This form is provided by the Florida AAU Volleyball Program for the player's medical release regarding his/her medical care and treatment necessary.

Florida Medical History And Release Form For Player
Florida Medical History And Release Form For Player
FLORIDA AAU VOLLEYBALL PROGRAM
MEDICAL HISTORY AND RELEASE FORM
This form must be carried with the coach during all training and competitions. Please complete all sections
of this form. Both the player and his or her parent/guardian must sign in all appropriate areas. By signing this
form, the participant and parent/guardian affirms they have read and understand it.
(CIRCLE ONE) M F
L
AST NAME FIRST NAME MI
STREET ADDRESS
CITY STATE ZIP CODE
/ /
BIRTH DATE AGE SOCIAL SECURITY NO. AAU MEMBERSHIPS NO.
TEAM NAME DIVISION HEIGHT WEIGHT
The Participant, , has permission to participate in the AAU Junior
National Volleyball Program. I certify that the participant has full medical insurance with the company listed below
and is physically fit to engage in the activities of the program. I approve the leaders and coaches of this program
and recognize that they will serve to the best of their ability.
MUST SIGN: Date:
PARTICIPANT SIGNATURE
MUST SIGN: Relationship:
PARENT/GUARDIAN SIGNATURE
Print Name:
PARENT/GUARDIAN HOME PHONE WORK PHONE
STREET ADDRESS CITY STATE ZIP
DOES THIS POLICY COVER SPORTS RELATED ACCIDENTS
INSURANCE COMPANY GROUP POLICY # (CIRCLE ONE) YES NO
MEDICAL RELEASE:
If my son or daughter should become ill or sustain an injury during his or her activities of the volleyball program, I
hereby authorize you to obtain emergency medical/dental care.
SIGN:
Date:
PARENT/GUARDIAN SIGNATURE
I do not authorize emergency medical/dental care for my son or daughter.
SIGN:
Date:
PARENT/GUARDIAN SIGNATURE
Florida Medical History And Release Form For Player
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