If you are human, leave this field blank. Player Name: * Returning Player? * No Yes Team Name (Prior Year if Applicable) Age: * Date of Birth: * Parents or Legal Guardian: * Address: * City: * State: * Zip: * Home Phone: * Work Phone: Cell Phone: Email Address: * In case of emergency, if parents can not be reached, please notify: * Family Physician: * Family Physician Phone Number: * Insurance Company: * Insurance Policy Number (if known): Allergies? No Yes Previous Serious Illness: If you have allergies - please list: Current Medications: I hereby authorize SGCSA to seek medical treatment for my above-named child in the event of an emergency in which neither parent nor legal guardian can be reached. I also authorize any licensed physician or medical treatment center to provide medical care for my above-named child in case of an emergency. This consent shall be effective from the date it is executed until the date I terminate it in writing. I also understand that SGCSA does not carry team sports insurance. My above-named child participates with the full knowledge that I, as the parent, am fully responsible in case of any injury and I attest that there are no medical conditions that would preclude my child from participating at this time. By signing this form, I agree to hold SGCSA and its agents harmless from all actions and costs arising from my child participating in this sport if he/she was to be injured or disabled permanently or temporarily. I do hereby assume all risks associated with participation in soccer activities. * No Yes By clicking "submit" you are acknowledging that the form information is accurate to the best of your knowledge and granting SGCSA the right to use it as needed and as it relates to league participation.