*Last Name:  

*Last Name:  

Cell Phone:  

MEDICAL/LIABILITY RELEASE
I, the parent/legal guardian of the above-named player, a minor, or a player age18 or over, agree that I and the player will abide by the rules and regulations of the U.S. Youth Soccer (USYS), and its affiliated organizations, and the California Youth Soccer Association, Inc. (CYSA), and its affiliated organizations.  I, for myself and the player and our respective heirs, administrators and successors, intending to be legally bound, hereby release and indemnify the USYS and CYSA Parties, the owners and operators of the facilities used for the Programs, and their respective directors, officers, employees, agents and representatives from and against all claims, liabilities, damages or causes of action arising out of or in connection with the player’s participation in the Programs including, without limitation, player’s transportation to/from any Program, which transportation is hereby authorized.  I further grant the USYS and CYSA Parties the right to use player’s name, picture and/or likeness in printed, broadcast and other material concerning the Programs provided such use is related to the player’s status as a participant in the Programs.
As the parent/legal guardian of the above-named player, or player age 18 or over I hereby give consent for emergency medical care prescribed by a duly licensed EMT, Paramedic, Doctor of Medicine or Doctor of Dentistry.  This care may be given under whatever conditions are necessary to preserve the life, limb or well-being of my dependent.