Youth Soccer Travel Permission Slip

Participant Information

Participant Name: Date of Birth: Team Name: Coach Name:

Trip Details

Destination: Trip Dates: Purpose of Trip: Chaperone(s):

Parent/Guardian Contact Information

Name: Phone: Email:

Emergency Contact

Name: Relationship: Phone:

Medical Information

Allergies/Medical Conditions: Medications: Doctor Name & Phone:

Permission Statement

I hereby give permission for my child to travel with the team and team representatives to the soccer event described above. In case of emergency, I authorize medical care as deemed necessary by emergency personnel.