Youth Hockey Tryout Medical Release
Participant Information
Participant Name
Date of Birth
Address
Parent/Guardian Name
Phone Number
Email
Emergency Contact Information
Emergency Contact Name
Relationship
Emergency Contact Phone
Medical Information
Allergies (if any)
Medical Conditions / Medications
Physician Name
Physician Phone
Insurance Carrier
Policy Number
Medical Release Authorization
I hereby authorize the staff of the Youth Hockey Tryouts to act according to their best judgment in any emergency requiring medical attention, and I hereby waive and release them from any and all liability for injuries or illness incurred at the tryouts.
Parent/Guardian Signature
Date