GBSL - Medical Release Form 

Greece Boys Soccer League          

PARENT'S MEDICAL RELEASE

My child is hereby granted permission to attend and participate in the GBSL. My child is physically capable of participating in the GBSL In exchange for the privilege of participating in this program, I hereby waive any legal claim against those associated with this program if my child is injured while residing at and/or participating in the program at locations to which he has been invited. In my absence I hereby give my consent, in case of injury, to have the coach, an athletic trainer and/or doctor of medicine or dentistry or an Emergency Medical Team provide my child with medical assistance and/or treatment.

Boy's Name: __________________________________ Phone: _____________

Address: _________________________________________________________ 

City: _________________________ Zip: ____________

Birth Date: ________________

____________________________________ ____________________________
Signature of parent/guardian                           Emergency Phone Number

Medical and/or Hospital Insurance Company: _________________________________

Policy Numbers: _______________________________________________________

Known allergies or other pertinent medical information: _________________________

Emergency Phone Number Other than Parent/Guardian:

___________________________________________ __________________
Name                               Relation                                  Phone Number