Skyline Men's Soccer 2017 Emergency Info
This information will be shared with the appropriate school staff. If the designated parties on this sheet are not available, I understand appropriate emergency care deemed advisable by school authorities will be sought. Any special directions appropriate to my child have been checked and noted on this sheet.
Players Last Name
Your answer
Players First Name
Your answer
Address
Street, City, Zip
Your answer
Players Birth Date
MM
/
DD
/
YYYY
Home Phone Number
123-456-7890 or N/A
Your answer
Parent/Guardian #1 Name
Last, First
Your answer
Parent/Guardian #1 Cell Phone Number
123-456-7890 or N/A
Your answer
Parent/Guardian #1 Work Phone Number
123-456-7890 or N/A
Your answer
Parent/Guardian #2 Name
Last, First
Your answer
Parent/Guardian #2 Cell Number
123-456-7890 or N/A
Your answer
Parent/Guardian #2 Work Phone Number
123-456-7890 or N/A
Your answer
Emergency Contact Name
Last, First (someone other than parent/guardian)
Your answer
Emergency Contact's Phone Number
123-456-7890
Your answer
Prefered Hospital
Hospital Name or Closest
Your answer
Please select appropriate boxes that indicate player conditions
Please list any life threatening allergies and reactions
Medicine or drug, food, insect, none, ...
Your answer
Electronic Signature
Please type your name
Your answer
Today's Date
MM
/
DD
/
YYYY
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