Medical Release Form
Player Name *
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Known Allergies to medications or other medical issues *
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Emergency Contact Numbers *
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Special Medical Power of Attorney
As a parent or guardian, I do herewith authorize the treatment by a qualified, licensed medical doctor that is attending physician, may endanger his or her life, cause disfigurement, physical impairment or undue discomfort if delayed.

This authority is granted, only after a reasonable effort has been made to reach me. The release is completed and signed of my own free will and for the purpose of authorizing medical treatment under emergency circumstances in my absence.

Entering your name below indicates that you have read and agree to the Special Medical Power of Attorney and understand *
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