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PLAYER MEDICAL RELEASE FORMPWYS2020-07-31T17:10:39+00:00

Player Interest From

Player Information

Player's Name(Required)
MM slash DD slash YYYY
Soccer Position(Required)
Tell us your preferred position(s)
Have you played competitive soccer before?(Required)
Which team do you want to join(Required)

Parent Information

Parent's Name(Required)
Address(Required)
Waiver Consent(Required)
Waiver: Recognizing the possibility of injury or illness, accepting my son(s)/daughter(s) as a player in this soccer program, I consent to my son(s)/daughter(s) participating in the Play Where You Stay soccer program. Further, I hereby release, discharge, and otherwise indemnify Play Where You Stay, its related entities, sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the program, against any claim by or on behalf of my player son(s)/daughter(s) as a result of my son(s)/daughter(s) participation in the program and/or being transported to or from the programs. I hereby authorize the transportation of my son(s)/daughter(s) to or from the program. I give my consent to have a coach and/or licensed medical doctor or dentist provide my son(s)/daughter(s) with medical assistance and/or treatment and agree to be financially responsible for the reasonable cost of any such assistance and/or treatment.
By typing your name below, you are signing this application electronically. You agree your electronic signature is the legal equivalent of your manual signature on this application.
Photo Video Consent
Play Where You Stay takes photographs/video of players and staff during practices and games for the purpose of promoting Play Where You Stay. The inclusion of your name below releases and discharges Play Where You Stay from any and all claims arising out of the use of photographs/video, or any right that the parent(s) or minor(s) may have.

Title

Contact

    • 1.901.310.5242
    learn@playwhereyoustay.org
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