Please give details if you answered Yes to any of the above (use separate sheet if necessary):

I understand that it is my responsibility (as a player over 18, or the parent/guardian of a player under 18) to keep the team Trainer advised of any changes in the above information as soon as possible. In the event of a medical emergency and that no one can be contacted, Team management will arrange to take my child/myself to the hospital or a physician if deemed necessary.

I hereby authorize the physician and nursing staff to undertake examination, investigation and necessary treatment of my child/myself.

I also authorize the release of the information in this document, as well as treatment information to the appropriate people as deemed necessary (physician, medical staff, coach, team delegate).