New York Player Information And Medical Release Form
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Irondequoit Soccer Club
P.O.Box 67481
Rochester, NY 14617

PLAYER INFORMATION AND MEDICAL RELEASE FORM
Name

Birthdate

Address

Phone #

City, State

Zip

Responsibility:
I will conduct myself in a manner respecting the facilities, other players, referees, coaching and administrative staff of the
Irondequoit Soccer Club. Further, I understand that if I am found to be using or in possession of drugs or alcohol or in
violation of the ISC and/or hosting facility's rules and regulations, this shall result in my immediate ejection from the program.
Signature of Player

Date

PARENT'S APPROVAL AND MEDICAL RELEASE
My child is hereby granted permission to attend and participate in the ISC program. I have read the above paragraph and
fully understand and accept the responsibilities as they are outlined. My child has received a physical examination by a
physician and has been found physically capable of participating in the ISC program. In exchange for the privilege of
participating in this pro