Parental Consent and Waiver Form
for Youth Soccer

Participant Information

Participant Name:

Date of Birth:

Address:

City/State/ZIP:

Parent/Guardian Information

Parent/Guardian Name:

Phone Number:

Email:

Emergency Contact

Name:

Phone Number:

Medical Information

Allergies or Medical Conditions:

Medications:

Consent and Waiver

I, the undersigned parent or legal guardian, give my permission for the above-named participant to attend and participate in all activities of the youth soccer program. I understand that participation in soccer involves risk of injury, and I hereby waive, release, and discharge the organization, its staff, volunteers, and representatives from any and all liability for any injury or illness suffered by the participant in connection with their participation.

I certify that my child is physically fit to participate in soccer and that I have disclosed any relevant medical conditions above. In the event of an emergency and if I cannot be reached, I authorize the organization to seek medical treatment for my child.

I have read and agree to the Consent and Waiver above.

Parent/Guardian Signature: