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medical release

PARENT/GUARDIAN CONSENT AND MEDICAL RELEASE Recognizing the possibility of injury or illness, and in consideration for Atletico Indiana fc and members of Atletico Indiana fc accepting my son/daughter as a player in the soccer programs and activities of Atletico Indiana fc and its members (the "Programs"), I consent to my son/daughter participating in the Programs. Further, I hereby release, discharge, and otherwise indemnify Atletico Indiana fc, its member organizations and sponsors,their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son's/daughter’s participation in the Programs and/or being transported to or from the Programs. I hereby authorize thetransportation of my son/daughter to or from the Programs.My player son/daughter has received a physical examination by a licensed medical doctor and has been found physically capable of participating in the sport of soccer. I have provided written notice, which is submitted in conjunction with this release and attached hereto, setting forth any specific issue, condition, or ailment, inaddition to what is specified above, that my child has or that may impact my child's participation in thePrograms. I give my consent to have an athletic trainer and/or licensed medical doctor or dentist provide my son/daughter with medical assistance and/or treatment and agree to be financially responsible for thereasonable cost of any such assistance and/or treatment.____________________________________________________________________ signature of parent/gaurdian ___________________date_________________________

atletico indiana fc

ADDRESS:
st john indiana
PHONE:
219-310-5551
EMAIL:
jim@atleticoindianafc.com
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