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Please print this page, fill out the form completely and return it, along with a check payable to: "TS Performance Training"
Medical Release The undersigned parent or legal guardian and athlete hereby acknowledge speed & strength training, sports participation, along with physical activity in general can cause serious injury and such undersigned hereby assume the risk of such possible injury. The undersigned also hereby agree to indemnify and hold harmless TS Performance Training, Hampshire Hills, Hampshire Dome, Tyngsboro Sports Center, In The Net Soccer Academy, LLC., their directors, coaches, employees, trainers, agents, and representatives from any loss, damage, award, judgment, or other liability, however characterized, including attorney fees, resulting from injury, or damage to the property or person of the undersigned athlete, his or her parents, or legal guardian, resulting directly or indirectly from such athlete’s participation in any speed, strength, and agility; sports participation; practices, games or other events. I hereby give my permission for emergency medical attention necessary to be administered to my child _______________________in the event of an accident, injury, sickness, etc. until such time as I may be contacted. This release is given for a period of one year from the date given below. I also assume responsibility for payment of such treatment. TS Performance Training and or In The Net Soccer Academy may also use my child’s picture and or video taken at camps for promotional purposes. Parents Name: ______________________________________________ Street/City/St./Zip: ______________________________________________ Phone: ______________________________________________ Email: ______________________________________________ Insurance Co.: ______________________________________________ Policy Number: ______________________________________________ Physician: _______________________ Phone: ________________ Known Allergies or Medical Problems: _________________________________ ________________________________________________________________ Signed: ___________________________________________ (Parent or Guardian) Date: _______________
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