2021-2022 Ovid-Elsie Soccer Club Registration
Parent/Guardian Consent and Player Medical Release Form

Please fill out one form per player

**There will be a fee for each season of play. There will be an additional cost for uniforms.**

Fees will be assessed after registrations are finalized.
Email *
Player's Name *
Date of Birth *
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Gender *
Street Address *
City *
State *
Zip Code *
Number of Years Playing Youth Soccer *
Player Status *
Season Options *
Player Allergies (N/A if none) *
Player Other Medical Conditions (N/A if none) *
Uniform Shirt Size (**uniform costs will be in addition to seasonal fees**) *
Uniform Shorts Size *
Uniform Socks *
Parent/Guardian #1 Name *
Parent/Guardian #1 Cell Phone *
Parent/Guardian #1 Work Phone *
Parent/Guardian #1 Email *
Parent/Guardian #2 Name
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 Work Phone
Parent/Guardian #2 Email
Emergency Contact #1 Name (not parent) *
Emergency Contact #1 Cell Phone *
Emergency Contact #2 Name (not parent) *
Emergency Contact #2 Cell Phone *
Player's Physician *
Physician's Phone *
Medical and/or Hospital Insurance Company *
Policy Holder's Name *
Policy Number *
Group Number *
PARENT/GUARDIAN CONSENT AND MEDICAL RELEASE Recognizing the possibility of injury or illness, and in consideration for US Youth Soccer and members of US Youth Soccer accepting my son/daughter as a player in the soccer programs and activities of US Youth Soccer and its members (the "Programs"), I consent to my son/daughter participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify US Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son's/daughter’s participation in the Programs and/or being transported to or from the Programs. I hereby authorize the transportation of my son/daughter to or from the Programs. My player son/daughter has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, in addition to what is specified above, that my child has or that may impact my child's participation in the Programs. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment. **By printing my name, I agree to the above consents and releases.** Parent/Guardian Signature *
Today's Date *
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Interest in Coaching or Managing
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