Medical Release Form

Medical Release Form
Event Participating *

4th-6th UFL (Feb 19-21)
Start Date of Event *

- Month - Day Year
End Date of Event *

- Month - Day Year
Participant Information
Participant's Name *

First Name Last Name
Participant's Phone Number *

- Area Code Phone Number
Participant's E-mail
School Information
School Name *
Year of Graduation
Emergency Contact Information
Emergency Contact Name *

First Name Last Name
Emergency Contact Phone *

- Area Code Phone Number

Participant Signature
Cross Training Football has my permission to use any photos or video taken of me during camp for instructional purposes and/or publicize future events: *

Yes No
Cross Training Football does not provide medical insurance for any participant. In the event of illness or injury requiring treatment or hospitalization, family medical insurance must be used. Parents will be billed directly for any medical care given at the local hospital. I understand that I may sustain an injury to the extent of broken bones, sprains, strained, chipped or lost teeth, paralysis, or even death. In understanding this, I do hereby release Cross-Training Football and their respective employees, members and volunteers from any liability in the event of accident, injury or death. The above information has been explained by the CTF Staff and I and my parent/ guardian understand that I am playing at my own risk. CTF does not insure any injury that may occur during the event on or off the field. By signing in the area below, I stating that I am in agreement with these terms. (Please use your mouse to make the signature) *

Signature for participant -Use your mouse to make the signature Clear
Date of Signature *

- Month - Day Year
Parent or Guardian Signature
Cross Training Football has my permission to use any photos or video taken of my child during for instructional purposes and/or to publicize future events: *

Yes No
Cross Training Football does not provide medical insurance for any participant. In the event of illness or injury requiring treatment or hospitalization, family medical insurance must be used. Parents will be billed directly for any medical care given at the local hospital. I understand that I may sustain an injury to the extent of broken bones, sprains, strained, chipped or lost teeth, paralysis, or even death. In understanding this, I do hereby release Cross-Training Football and their respective employees, members and volunteers from any liability in the event of accident, injury or death. The above information has been explained by the CTF Staff and I and my parent/ guardian understand that I am playing at my own risk. CTF does not insure any injury that may occur during the event on or off the field. By signing in the area below, I stating that I am in agreement with these terms. Parent or Gardian's Signature (Please use your mouse to create the signature) *

Parent or Guardian Signature (Please use mouse to complete the signature) Clear
Parent or Gardian Name

First Name Last Name
Date of Signature *

- Month - Day Year
E-mail for confirmation to be sent:
Should be Empty:

Medical Release Form

Participant Information

School Information

Emergency Contact Information

Participant Signature

Parent or Guardian Signature