Medical Treatment Authorization and Liability Waiver/Release:
I hereby give my consent, on my own behalf or on behalf of my child or guardian, as applicable, to have an athletic trainer, coach, team manager, emergency medical technician, physician, nurse, dentist, or other healthcare professional, and in each case, their associated personnel provide the player identified with medical assistance and/or treatment and agree to be financially responsible for the cost of such assistance and/or treatment. I understand treatment for injury will be based, at least in party, on information provided herein. I hereby authorize emergency transportation of the player listed above, at player and parent/guardian’s expense, to a healthcare facility should an individual listed consider it to be warranted. I acknowledge and understand that certain risks of injury (including, but not limited to concussions, other serious bodily injury or death)are inherent in playing soccer. These types of injuries may result from the player’s actions, the actions or inactions of others, or a combination of both. In sighing below, I certify that the player received all necessary medical clearances to participate fully in all US Club Soccer programs without restriction or condition. To the maximum extent permitted by law, I hereby agree to release, waive, hold harmless and indemnify the member organization, the National Organization of Competitive Soccer Clubs (dba US Club Soccer), its agents, contractors and sponsors, US Soccer and its affiliated organizations, and the employees and associated personnel of these organizations, against any claim by or on behalf of the player named above as a result of the player’s participation in US Club Soccer programs and/or being transported to or from the same, which transportation I hereby authorize.
