Complete Player's Name _______________________________________________________

Complete Adress _____________________________________________________________

Phone Number _______________________________________________________________

Email Adress ________________________________________________________________

Team or Institution's Name ____________________________________________________

Medical Insurance Company Name & Policy Number ________________________________

____________________________________________________________________________

Daytime Phone #s
Father (home)__________________   (work)________________   (cell)________________

Mother (home)__________________   (work)________________   (cell)_______________

In an emergency, if parents cannot be reached notify:

Name____________________________            Relationship_________________________

Phone#______________________________________________________________________

Family Doctor _________________________    Telephone ___________________________

Known Allergies_______________________________________________________________

Asthma _________________________    Diabetes _________________________________

Contact Lens ________________    Last Tetanus Shot or Booster _____________________

List of Medications Currently Taking ______________________________________________

____________________________________________________________________________

I, the undersigned parent or guardian, do hereby authorize the athletic trainer or coaches at the Deportivo Alaves   to secure any and 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/she may deem necessary.
It is understood that, in any event, an attempt will be made to contact the parent before treatment is initiated.
I, the undersigned, for myself, my heirs, & executors, waive, release and forever discharge the Deportivo Alaves and EUstudy Tours and all their affiliated entities from any and all liability, claims, demands, and causes of action for personal injury, property damage and/or other loss suffered by my child in connection with his participation in the International Deportivo Alaves Soccer Program.
I, the undersigned parent or guardian also certify that my child is physically fit to attend the International Deportivo Alaves Soccer Program and participate in all program activities.