FC DELCO U15 ID Clinic Waiver
To be filled out by a non-minor player or the parent or guardian of a minor player
Email address *
Player First Name *
Your answer
Player Last Name *
Your answer
Player Birth Date *
MM
/
DD
/
YYYY
Player Age *
Your answer
Parent First Name (if player is a minor) *
Your answer
Parent Last Name (if player is a minor) *
Your answer
Email Address (Or parent email address if player is a minor) *
Your answer
Phone (Or parent phone if player is a minor) *
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone Number *
Your answer
Current Club *
Your answer
APPROVAL AND MEDICAL RELEASE Recognizing the possibility of physical injury, I, the above-named player OR parent/guardian of the above-named player, a minor, do hereby release, discharge and/or otherwise indemnify the FC DELCO and its affiliated organizations including, without limitation, Continental FC and Spirit United SC, and their respective officers, coaches, referees, managers, board members, tournament hosts and their officials, employees and associated personnel, including the owners of the fields and facilities utilized for the Programs ("Programs," as used herein, means games, tournaments, clinics, practices, and/or soccer activities or social events organized by FC DELCO or its affiliated organizations), against any and all claims by or on behalf of the above-named player as a result of such player's participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize by the officer, coach or agent(s) of the FC DELCO. The above-named player has received a physical examination by a physician and has been found physically capable of participating in the Programs. I, the above-named player OR the parent/legal guardian of the above-named player, hereby give my consent to have an athletic trainer, doctor of medicine or dentistry, or other medical professional provide the above-named player with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of such assistance and/or treatment. This care may be given under whatever conditions are necessary to preserve the life, limb, or well-being of the above-named player. *
Required
Please Print Your Full Name as Your Signature: *
Your answer
Please select which date (s) you will attend: *
Required
A copy of your responses will be emailed to the address you provided.
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