Medical Waiver 2018-2019 Season

  1. I hereby give permission to the medical personnel selected by SFYS and it's adult staff to arrange for emergency medical treatment, order x-rays, routine tests, to release any records necessary for insurance purposes; and to provide or arrange necessary related transportation for my child. In the event I am unable to make decisions in an emergency, I hereby give permission to the physician selected by SFYS and its adult staff to secure and administer treatment, including hospitalization, for the child named below.
  2. I authorize approved staff members to transport my child in personal vehicles in case of events or emergencies

Form must be submitted to participate in SFYS Programs

Parent Name *
Parent Name
Child Name *
Child Name
Address *
Phone *
Emergency Contact *
Emergency Contact
Phone 1 *
Phone 1
Physician Name *
Physician Name
Physician Phone *
Physician Phone
Name of Policy Holder *
Name of Policy Holder
Insurance Phone *
Insurance Phone
YOUTH PARTICIPANT WAIVER AND RELEASE OF LIABILITY In consideration of my child, named above, being allowed to participate in camps, sports and recreation programs at SF Youth Sports Academy, the undersigned acknowledges and agrees that: Participation in camps, sports and/or recreational activities can result in physical injuries. While particular rules, equipment and personal discipline may reduce such risks, the risk of injury, including serious injury and disability, does exist. The undersigned, knowingly and freely assumes all such risks, both known and unknown, and assumes full responsibility for the participation of the minor child noted above. The undersigned, on his or her behalf, on behalf of the child noted above, and behalf of all heirs, assigns, personal representatives, and next of kin, hereby releases and holds harmless, to the extent permitted by law, SFYS, its officers, officials, agents and/or employees, its sponsors, and other participants and their families with respect to any and all injury, disability, death, loss, or damages to person or property The above waiver and release forms are valid for the year 2017-2018.
I have read this release of liability and assumption of risk agreement fully understand its terms and by submitting this form I am agreeing to it freely and without any inducement.