Player Intake and Medical Release Form

Athlete's Name *

Parent/Guardian's Name (If Under 18)

Email *

Phone *

Age

Skill level based on age?

Experience?

Current strengths?

Needs improvement list?

Emergency Contact Name

Emergency's Phone Number

Please list any medical conditions that the Athlete might have of which the medical authorities should be aware in order to administer medical treatment:

I, (parent/guardian of minor participant or the adult participant), do hereby give my permission for the participant to take part in EF GOALS activities. I do hereby release, absolve, indemnify, and hold harmless EF GOALS and all others listed hereafter: organizers, employees, officers, board members, coaches, referees, sponsors, supervisors, and building owners permitting the use of their building for activities, any

and all of them.

I understand that in the event that medical treatment is required, every effort will be made to contact the parents, guardians, and emergency contacts listed above. However in the event they cannot be reached, I give my permission to the EF GOALS staff, coaches, officers, volunteers, or sponsors to secure the services of a licensed physician to provide the care necessary, including anesthesia for my participant's well being.

Choose One

Adult Athlete

Parent/Guardian on behalf of Mine

Today's Date

eSignature