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CLUB NAME: ______________________________________

DATE:____________________

NATIONAL ASSOCIATION :____________________________

AGE GROUP :______________

ID NUMBER: _______________________________

NAME OF PLAYER:

_________________________________________

DATE OF BIRTH :

_________________

PASSPORT NO:

___________________________________

NAME OF COACH :

_____________________________

NAME OF MANAGER :

_____________________________

PLAYER'S SIGNATURE:

_____________________________

MOTHER'S NAME: __________________________

FATHER'S NAME :_____________________

ADDRESS : _______________________________________________________

TELEPHONE:_________________

EMAIL:_____________________

EMERGENCY CONTACT(OTHER THAN PARENTS):

NAME:__________________ NO.___________________

Consent For Medical Treatment (Minor)
As the parent or legal guardian of the above named player, I hereby give consent for emergency medical care prescribed by a duly licensed Doctor of Medicine or Doctor of Dentistry. This care may be iven under whatever conditions are necessary to preserve the life , limb or well being of my dependent.

Signature of Parent or Guardian:_________________________________.