| Student Name: | |
| Date of Birth: | |
| Address: |
| Name: | |
| Phone: | |
| Emergency Contact: |
I, the undersigned parent/guardian, give permission for my child to travel and participate with the above-named team in the listed tournament. I authorize the team coaches and representatives to act on my behalf in case of medical emergency and consent to any medical treatment deemed necessary.
| Parent/Guardian Signature: | Date: |