Norway Trip 2019 Travel Waiver and Acceptance Form (submit by May 31)
SC Gjøa Youth Soccer and their respective officers, employees, agents and representatives (collectively, the “Club”) are delighted your child plans on participating in this year’s Norway Cup. To participate, this form must be completed in full only by parents/legal guardians of each individual player attending the Norway Trip 2019.


To complete this form you will need the following: passport info, health insurance and medical info, contact information for players and emergency contacts.  

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By checking AGREE, you acknowledge and confirm that you agree (1) to the validity of this electronically created and signed form agreement with the Club, and (2) that such form shall have the same legally binding effect upon you and your Player as if it were an agreement executed by you and the Club on paper and signed by pen. *
Required
Parental Verification: by checking Agree, you confirm you are a parent or legal guardian of the minor child listed in this form (only players born prior to May 1, 2001 may complete this form without parent/guardians) *
Submitter First Name (parent/legal guardian only) *
Submitter Last Name (parent/legal guardian only) *
Submitter Email Address (parent/legal guardian only) *
Submitter Mobile Phone Number (parent/legal guardian only) *
Submitter Relationship to Player *
Player Passport Surname *
Player Passport Given Names *
Player Passport Number *
Player Passport Nationality *
Player Passport Date of Birth *
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DD
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YYYY
Player Passport Place of Birth *
Player Passport Gender *
Player Passport Date of Issue *
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DD
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YYYY
Player Passport Date of Expiration *
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YYYY
Player Email Address
Player Phone Number (only if it is working while in Norway)
Player Health Insurance Provider *
Player Health Insurance Primary Insured Name *
Player Health Insurance Account/ID Number *
Emergency Contact First and Last Name *
Emergency Contact Phone Number *
Emergency Contact Email *
Emergency Contact Location July 26 - August 4, 2019 *
Will Player have a Parent and/or Legal Guardian present in Norway for all or part of the 2019 trip (July 26th - August 4th)? *
If you answered, "Yes, part of the trip," please provide exact dates in Norway. If Parent/Guardian in Norway is different than submitter above, please provide contact name, email and phone number.
General Permission and Waiver.  You grant permission for your Player to fully participate in the Norway Cup and its various programs, events, travel and sporting and non-sporting activities.  You understand and acknowledge that your Player may incur personal or property injury, damage or loss while participating in such activities.  You certify that you will accurately and completely communicate and describe to the Club all past injuries, medical conditions or other pre-existing conditions that may adversely affect or in any way limit your Player’s ability to participate in Norway Cup 2019 activities.  You certify that no qualified medical health professional has advised against your player’s participation and that there are no other health reasons which preclude your Player from participation.  By signing this agreement, you assume all such risks inherent in your Player’s participation in these activities and accept full responsibility, and will hold the Club harmless and release the Club of all liability, for any injuries or personal or property damages or losses of any kind incurred while participating in these activities. *
Required
Additional Waivers - by checking Yes, you acknowledge that during registration for the Norway Trip you accepted verifications, releases and waivers for: Parental Verification, Refunds, Image Release, and Code of Conduct (contact register@gjoa.org for waiver copies, if needed) *
Clear selection
Does your player have any current or past injury or pre-existing condition that will affect or in anyway limit your Player’s ability to participate in the Norway Cup activities? If yes, please describe below. If no, type No. *
Does your player take prescription medication? *
Required
If YES, complete items 1 through 8. If NO, skip to the Non-prescription Authorization
1. Describe diagnosis requiring prescription medication
2. Medication prescribed and dosage
3. Instructions for administering prescription medicine (note: medicine must be provided in a pharmacy container indicating the Player’s Name as well as complete instructions for dispensing. Prescribing labels that state “Take as Directed” will NOT be accepted.)
4. Side effects of the prescribed medicine
5. Physician name
6. Physician phone number
7. Prescription Authorization: I grant permission to the Norway Trip coaching and chaperone staff to assist in the administration of each prescribed medication to be provided
Clear selection
8. Prescription Waiver: by checking Agree, you hereby release and hold SC Gjøa Youth Soccer and their respective officers, employees, agents and representatives harmless from any liability for administering prescription medications
Non-prescription Authorization: by checking Agree, you grant permission to the Norway Trip coaching and chaperone staff to assist in the administration of non-prescription medications, as needed. This may include over-the-counter pain relievers, antibiotic ointments, cough drops, and other non-prescription remedies. (Important note: if sending non-prescription medicines with your player, they must have the player's name on them and be in the original packaging with doses and directions for administration.) *
Non-prescription Waiver: by checking Agree, you hereby release and hold SC Gjøa Youth Soccer and their respective officers, employees, agents and representatives harmless from any liability for administering non-prescription medications *
Required
Medical Attention Authorization: by checking Agree, you grant permission to the Norway Trip coaching and chaperone staff to seek medical attention for your child as needed, including seeking medical attention from a clinic, hospital, doctors office, urgent care, or other health facility. *
Medical Attention Waiver: by checking Agree, you hereby release and hold SC Gjøa Youth Soccer and their respective officers, employees, agents and representatives harmless from any liability in seeking medical attention for your child. *
Required
Travel Authorization (only for players on escorted flights): by checking Agree, both parents and/or all legal Guardians give permission that the minor child listed in this form may travel internationally with the SC Gjøa Director, Lee Kellett and the SC Gjøa coaching staff and chaperones. (The parent NOT submitting this form must enter name below.) *
Required
Second Parent/Guardian Travel Authorization Signature: by entering your name you are signing the Travel Authorization agreed to above - if not on escorted flight(s) type "not applicable" *
If you have more than one child going to Norway, please fill out this form for each one - once you click Submit you will be offered a link to Submit another response.
By clicking the SUBMIT button below, you confirm you: (1) have carefully reviewed, understand and agree to all terms, conditions and waivers presented, (2) certify all statements provided by you are accurate and complete to the best of your knowledge, and (3) hereby adopt the name you type below as your electronically provided signature confirming your intent to be bound to all of the above.  (Type your name below as your signature, then click SUBMIT) *
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