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SUMMER LEAGUE WAIVER

2017 HS GIRLS LEAGUE MEDICAL WAIVER FORM

***THIS FORM IS REQUIRED FOR ALL PLAYERS AND IS DUE AT FIRST GAME.NO PLAYERS WILL BE ALLOWED TO PLAY WITHOUT THIS FORM ON FILE***

EFC......SOUTHEASTERN MASSACHUSETTS PREMIER SOCCER CLUB

Players team(s) that  they will be participating in this League________________________________________________________

Player Full Legal Name as appears on players birth certificate:_______________________________________________________

Players address___________________________________________________________________________________________

Players state______________ Players Zip________________

Players home phone____________________________ Players cell phone_______________________________

Players DOB_________________________________ Players Gender ____________ (Male or Female)

Mother/Guardian name________________________________________________________________

Mother/Guardian cell phone _______________________________

Father/Guardian name ________________________________________________________________________

Father/Guardian cell phone ____________________________________________________________________

Players known medical problems_________________________________________________________________

Players doctor __________________________________________ Doctors phone __________________________________

Emergency contact name _________________________________ phone________________________________________

By signing below, I, The Parent/Guardian of the registrant, a minor, (or, if the registrant is an adult: I, the selfsame as the registrant) agree that I and the registrant will abide by the rules of Mass Youth Soccer, US Youth Soccer, Explosion FC, its affiliated Organizations and sponsors.  Recognizing the possibility of physical injury associated with soccer and it consideration for the EFC HS girls summer league accepting the registrant for its soccer programs and activities (the Programs), I hereby release, discharge and/or otherwise indemnify the Mass Youth Soccer/US Youth Soccer, Explosion FC, its affiliated Organizations and sponsors, their employees and associated personnel, including owners of fields and facilities utilized for the Programs, and all coaches against any claim by or on the behalf of the registrant as a result of the registrants participation in the Programs and/or being transported to or from the same, which transportation I hereby authorize. I also agree that the aforementioned organizations have my full consent to attain and administer emergency medical care to my minor soccer player by all means necessary to preserve life and limb in my absence.  ADDITIONALLY I GIVE MY PERMISSION FOR EFC TO USE MY PICTURES FROM SOCCER GAMES ON SOCIAL MEDIA, EFC WEBSITE AND IT'S ADVERTISING CAMPAIGN AT EFC'S DISCRETION. 

Parent or adult players signature:_________________________________________________________________________________________ Date_____________________


Questions: Dave Hamel    d102928@aol.com  www.explosionfc.com

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