Please Sign or Initial Below before submitting: CONSENT TO PLAY AND CONSENT FOR MEDICAL RELEASE: I, the parent/guardian of the registrant, a minor, agree that the registrant and I will abide by the rules of the league, its affiliated organizations and sponsors. Recognizing the possibility of physical injury associate with field hockey and in consideration for the league accepting the registrant for its program and activities (the “Programs”), I hereby release, discharge and/or otherwise indemnify Worcester Field Hockey, its affiliated organizations, sponsors and their employees and associated personnel, including the owner of the fields and facilities utilized for the programs, against any claim by or on the behalf of the registrant as a result of the registrant’s participation in the programs and/or being transported to or from the same which transportation I hereby authorize. As parent or Legal Guardian of the above-named player, I hereby give my consent for emergency medical care prescribed by a duly licensed Doctor of Medical or Doctor of Dentistry. This care may be given under whatever conditions are necessary to preserve life, limb or well being of my dependent. Parent/Guardian’s Name _________________________ Parent/Guardian Signature_____________ Date____________________ *
