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First Aid / CPR Refusal and Waiver of Liability
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Your Email Address
Child Name *
Date of Birth *
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DD
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Allergies (list all) *
Parent Name *
Phone Number *
Emergency Contact: Name and Relation *
Emergency Contact Phone Number *
Please check the actions that our coach should not administer to your child *
Required
I hereby waive any claim for myself, my heirs, executors, assigns, or personal representative that I might have against Super Soccer Stars, against any and all claims, damages, or causes of action arising out of failure to apply first aid or administer CPR to my child. Please note that coaches will not be able to administer any medications (allergy medicine, epi-pens, etc.) *
Required
Parent Name *
Date *
MM
/
DD
/
YYYY
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