East Duplin High School - Medical Waiver Form

Tuesday, February 9, 2010

East Duplin High School

Indoor Soccer Tournament

Beulaville, N.C.

Thanksgiving Clash							Wall Bangin' Bash

Tournament Team Roster

Team Name:	Contact Name, Address, and Phone #:	Age Bracket U- _____
Player's Name		Birth date
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Medical Waiver Consent

I, the undersigned participant or parent/guardian of the listed player, does hereby grant the staff of EDHS/EDBC the authority to render judgment concerning medical assistance or hospital care in the event of accident or illness. Additionally, in return for the privilege of playing in the tournament I hereby hold EDHS/EDBC owners, administrators, club officers and employees harmless in the event of injury.

Player's Name	Printed Name of Parent/Guardian	Signature
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*Entry Fee Paid: ___________ Date: ____/____/___