Medical & Media Release

Soccer Skills Saturday - Presented by Drover Soccer

Player Name

First Name

Last Name

Player DOB

Player Gender

Male

Female

Prefer Not to State

Emergency Contact Name(s)

First Name

Last Name

Emergency Contact Email(s)

Emergency Contact Phone #(s)

Allergies that impact soccer (list all)

Medications that impact soccer (list all)

Consent to allow the coaches and staff members of ‘Soccer Skills Saturday’s’ to take pictures and short videos during the sessions. I understand that some of this media may be used on social media at a later date

Agree

Decline