Richmond Heights Conquerors

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Player Information Form

PLAYER INFORMATION

* First Name:

* Last Name:

Street:

City:

State:

Zip Code:

Home Phone:

Birthdate:

Email:

Gender:

Grade:

PARENT/GUARDIAN #1

Firstname:

Lastname:

EMail:

Home Phone:

Work Phone:

Cell Phone:

PARENT/GUARDIAN #2

Firstname:

Lastname:

Email:

Home Phone:

Work Phone:

Cell Phone:

MEDICAL/EMERGENCY CONTACT INFORMATION

Emergency Contact:

Phone:

Relationship to Player:

Insurance Carrier:

Policy #:

Alergies/Medical Conditions::

WAIVER INFORMATION

*I Hereby my signature grant permission for my child/ward to participate in any and all Conquerors and, American Youth Football, Inc / American Youth Cheer dba, program(s) sanctioned event(s), be
they official or un official, including but not limited to, athletic, social and/or fundraising activities. I further hereby
consent to any and all health care providers, authorize any first aid, emergency treatment, including but not limited to
transportation to and from health care facilities and/or any medical professional to provide treatment, order injections,
hospitalize, give anesthesia or perform surgery. I understand that this authorization is given prior to any need for
medical care, but given to avoid unnecessary delay in emergency treatment which the attendant and/or medical
professional may deem advisable in the exercise of best judgment. I presume a reasonable attempt was made to
contact me.

I/we agree with the above *

Signature:

Date:

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