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  • RYS Medical Release Form

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    Kate Sigurdson
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    The Randolph Youth Soccer medical release form collects information about a player including their name, grade, date of birth, known allergies and medical conditions. It gives consent for Randolph Youth Soccer officials or coaches to seek medical treatment for the player in case of injury or illness until the parent/guardian can be contacted, and allows physicians and other healthcare providers selected to provide any necessary medical care including emergency surgery. The parent/guardian must sign and date the form and provide their contact details as well as the player's doctor and insurance information.

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    Medical Release Form

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    The Randolph Youth Soccer medical release form collects information about a player including their name, grade, date of birth, known allergies and medical conditions. It gives consent for Randolph Youth Soccer officials or coaches to seek medical treatment for the player in case of injury or illness until the parent/guardian can be contacted, and allows physicians and other healthcare providers selected to provide any necessary medical care including emergency surgery. The parent/guardian must sign and date the form and provide their contact details as well as the player's doctor and insurance information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    508 views1 page

    RYS Medical Release Form

    Uploaded by

    Kate Sigurdson
    The Randolph Youth Soccer medical release form collects information about a player including their name, grade, date of birth, known allergies and medical conditions. It gives consent for Randolph Youth Soccer officials or coaches to seek medical treatment for the player in case of injury or illness until the parent/guardian can be contacted, and allows physicians and other healthcare providers selected to provide any necessary medical care including emergency surgery. The parent/guardian must sign and date the form and provide their contact details as well as the player's doctor and insurance information.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    Randolph Youth Soccer

    MEDICAL RELEASE FORM

    Player Name: ________________________________________________


    Player Grade: ______
    Player Date of Birth: ___________________
    As the parent/legal guardian of the player identified above, I hereby give my consent and
    permission for the player named above to be medically and/or surgically treated for injuries and/or
    illness of any kind or seriousness under the direction of Randolph Youth Soccer officials or
    coaches until such time as I can be contacted. Further, I give my consent and permission to the
    physician and/or hospital and/or other health care provider selected to provide medical or surgical
    treatment, including, without limitation, dental care, hospitalization, injection, anesthesia, invasive
    surgery or any other form or kind of medical or surgical care (emergency or otherwise).
    Name of Parent/Guardian:

    _______________________________________________________

    Signature of Parent/Guardian:_______________________________________________________
    Date: ______________
    Known allergies, including any allergies to medicine:
    ________________________________________________________________________________
    ________________________________________________________________________________

    Known Medical Conditions:


    ________________________________________________________________________________
    ________________________________________________________________________________
    Doctor: ____________________________________

    Phone: ________________________

    Insurance Carrier: ____________________________

    Policy #:_______________________

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