Valdosta City Lakercats

BIRTH CERTIFICATE/MEDICAL RELEASE FORM

* First Name:

* Last Name:

PARENT/GUARDIAN #1

Firstname:

Lastname:

Relationship to Player:

I ACKNOWLEDGE THAT A COPY OF BIRTH CERTIFICATE HAS BEEN SUBMITTED TO THE VALDOSTA CITY LAKERCATS IN ORDER TO PARTICIPATE DURING THE SPRING BASKETBALL SEASON.

I ACKNOWLEDGE THAT A SPORTS PHYSICAL HAS BEEN COMPLETED DURING THE CURRENT SCHOOL TERM AND THE PHYSICAL WILL BE ACTIVE UP TO AUGUST 1, 2019.

I ACKNOWLEDGE THIS PLAYER IS MEDICALLY CLEARED TO PARTICIPATE AND ALL MEDICAL HISTORY/RECORDS HAS BEEN REPORTED TO THE LAKERCAT STAFF.

*ALL DISTRICT(STATE) AND NATIONAL TOURNAMENTS REQUIRE UP TO DATE PROGRESS REPORT OR REPORT CARD IN ORDER FOR PLAYER TO PARTICIPATE IN THAT EVENT.

I/we agree with the above *

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BIRTH CERTIFICATE/MEDICAL RELEASE FORM