2011 AVON SOCCER CLUB MEMORIAL DAY TOURNAMENT
1.TO: AVON SOCCER CLUB GENERAL RELEASE
I hereby acknowledge that participation in Soccer competition carries with it potential hazard. I, therefore, release Avon Soccer Club and its team coaches, the officers and officials of the Tournament, and the Town of Avon, Ct., of liability in the event of injury during the Avon Soccer Club Memorial Day Tournament.
Participant's Signature: Participant's Birth date:
Parent/Guardian's Signature: Date:
Team Name: Soccer Club Affiliation:
CONSENT FOR EMERGENCY MEDICAL AID AND MEDICAL TREATMENT
I hereby give consent for my son/daughter, , to receive emergency medical treatment which may be deemed advisable in the event of accident or illness during the Avon Soccer Club Memorial Day Tournament, May 28, 29, and 30, 2011.
I understand that, if possible, I will be notified by telephone of any emergency treatment required.
Signature: Date:
Address: Telephone Number:
3. MEDICAL INFORMATION
Known Allergies:
Known Medical Problems:
Health/Hospital Insurance:
(name of insurer)
Certificate of Policy No.:
Name of Insured:
Personal Physician:
Address: Telephone Number: