Medical

Release Waiver
I, the undersigned, hereby certify that I hereby give my permission for the Chattanooga FC staff, during the period of the trial, to seek appropriate medical attention for me, and for medical attention to be given, and for me to receive medical attention in the event of an accident, injury, or illness. I will be responsible for any and all costs of medical attention and treatment and have medical insurance to cover these costs. I understand, as with any sport, injuries can occur, and hereby acknowledge that I am physically fit and mentally capable of participating in Chattanooga FC trial activities. I also acknowledge that I cannot hold Chattanooga Football Club or any of its staff, facilities, owners or any other related entities liable for any injuries or damages.

Print Name ________________________________________ E-mail Address _________________________________________ Phone Number (______)_______-_______________ Signature ______________________________________ Date _________________ Name & phone number of emergency contact person: ___________________________ List any known medical conditions, including previous or recurring injuries & date thereof: