High School Soccer Parental Consent Form

Student Information

Student Name Date of Birth Grade School

Parent/Guardian Information

Parent/Guardian Name Relationship to Student Phone Number Email

Emergency Contact

Emergency Contact Name Phone Number Relationship to Student

Medical Information

Allergies or Medical Conditions Medications Primary Physician Physician Phone

Consent & Agreement

I hereby give permission for my child to participate in the High School Soccer Program and understand that reasonable measures will be taken to safeguard the health and safety of my child. In case of emergency, I authorize the staff to secure any necessary medical treatment.