HVFC 2009 Summer Programs - REGISTRATION FORM

Program (CIRCLE ONE)

Player Name:                                                                                                                                                                                      

Player Age:                                                                            Player Grade:                                                                                        

Player Address:                                                                                                                                                                                   

Emergency Contact #:                                                            Email Address:                                                                                    

I, the undersigned parent or guardian, do hereby authorize the HVFC trainer or coaches to secure any & all medical treatment in the event that I cannot be contacted. I further authorize any attending physician to render any and all medical care which he or she may deem necessary. It is understood that, in any event, an attempt will be made to contact the parent before treatment is started. I, the undersigned parent or guardian, also certify that my child is physically fit to attend and participate in all clinic activities.

Parent/Guardian Signature:                                                                                                    Date: