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 MEDICAL RELEASE
MEDICAL RELEASE FORM
Function:
Player’s Name _____________________________________ U.S. Citizen Yes ______ No _____
Address: ______________________________________________________________________
City/State/Zip Code: _____________________________________________________________
Birthdate: ____________________ Sex: ___________ Social Security Number: ____________
Parent’s Phone: Home________________________ Work ______________________________
Include Area Codes
Emergency phone number other than Parent/Guardian
Name: ___________________________________________ Phone: ______________________
Include Area Code
Primary Medical Insurance Company: _______________________________________________
Policy Number: _________________________________________________________________
Known allergies or other pertinent medical information: _________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Recognizing the possibility of physical injury associated with soccer and in consideration for USYS/
USS and its affiliates accepting the registrant for its soccer programs and activities (the “Programs”)
I hereby release, discharge and/or otherwise indemnify USYS/USS, its affiliated organizations and
sponsors, their employees and associated personnel, including the owners of fields and facilities
utilized for the Programs, against any claim by or on behalf of the registrant’s participation in the
Program’s and/or being transported to or from the same, which transportation I hereby authorize. My
child has received a physical examination by a physician and has been found physically capable of
participating in the Programs.
Therefore, I grant __________________________________ and/or ______________________
permission to act as my surrogate for my child in the area of obtaining medical treatment by a
doctor of medicine or dentistry. I also assume the financial responsibility for any medical treatment
for my child.
Signature of Parent/guardian: _____________________________________Date: ____________
Subscribed and sworn to me this ____________________ Day of ____________ 20 ________
Signature ___________________________________ My commission expires _______________
Notary Public
WISDOM
WORDS OF WISDOM
If you think you are beaten, you are;
If you think you dare not, you don't!
If you'd like to win, but you think you can't,
It's almost certain you won't.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you think you'll lose, you're lost;
For out in the world we find
Success begins with a fellow's will;
It's all in the state of mind!
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
If you think you're outclassed, you are;
You've got to think high to rise.
You've got to be sure of yourself
Before you 'll ever win the prize.
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Life's battles don't always go
To the stronger or faster man;
But sooner or later the man who wins
Is the person who thinks he can!
-- Author Unkno
There is always
There is always a "better" team out there.
Players & teams who work hard reap rewards.
One of the great rewards is knowing on this day you were the best you have been yet.
The great players, or teams continue to work to get better.
For me these thoughts are what sport is about, and it's greatest gifts that will last a life time are:
challenge, commitment, determination, spirit.
The ability to lose well, and to know you will try again.
Now let me mention the gift & reward of being able to sweat & toil, for a cause greater then ones one, and it's by product...
putting something (the team) before one's self.
Self -sacrifice comes in many forms,on the balance beam, or the field, on the touchline, or on the bench, away from the TV, or in the classroom paying close attention, or up late doing homework, juggling more then ball to meet all of life's responsibilities, or missing birthday parties.
Glory & even more rewards come later, and in many forms.
There is even a "glorious loss", as in...When a division 6 teams plays a " premier team", losing only 4/0, but knows it played it's best game ever. All can walk away with their head held high because they gave and did their best.
There is always a better team out there. It is in being the best you can be that is the goal. Not the number of goals scored,
or the trophies lined up.
In seeing the improvement... that fuels the spirit, that rewards
the efforts, that allows you to reach for more, to work harder,
to dream to better matches, and to believe you can do it.
Being able to lose yet willing to try again.
Being fit, being competent, having faith in ones self, in ones team, having good sportsmanship,
earning respect from your teammates, from your opponents and giving that respect back.
Stop focusing parents on all the small stuff, on all the titles,
and trophies. Those are the little gifts.
Hopefully despite some of you & your attitudes, your children are realizing the important gifts from sports all on their own.
And parents, many of you seem to think the gifts of sport are meant for a select few, & that it's only joy is being #1.
There is no#1.
Sorry, there is always a better team, whether it's in a different division, different level, different part of your state, another state, lol, another country. Or one that comes from your division, or even a lower division. On any given day, one team can falter, one can rise, the underdog or long shot can surprise.
Placing such focus on winning the division, or Cup, or whatever is not what sport is about,
winning those things are the bonus....the icing on the cake. The real rewards were those gained along the way, and they come to all who give it their best, not just today's winner.
Conrats to winners in any division, may you continue to go on, try harder, get better.
Congrats to the losers in any division, going on, trying harder,
getting better these gifts are yours same as theirs.
So Congrats to the winner, the loser, the player who knows better then some of the parents.
To a few of you, I hope your parents narrow viewpoint don't blind you, the player, from all the gifts you have gained so far.
Be proud each and every day you lace your cleats, be gracious as you shake hands, win or lose, and know you did your best, and will try better next time.
And finally, I took great pride as a parent with kids on both sides of the score board.
Maybe with a bit more we must of done something right "gloat" when the youngest,
who lost 8/0, 6/0 for the first few seasons...
raced to get her home work done, laced up with smiles, and unlaced with the same smiles. While not at the top division,
no longer on the bottom, she knows, as do I that her whole teams efforts have paid off, and she and they & I have pride.
Having prid
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