WISCONSIN YOUTH SOCCER ASSOCIATION EVENT MEDICAL RELEASE FORM 2026-2027 SEASON

Player’s Name: 

Date of Birth (MM/DD/YY): 

Gender: M F 

Club: 

Parent 1 Name: 

Home Phone: 

Cell Phone: 

Parent 2 Name: 

Home Phone: 

Cell Phone: 

Emergency Contact: 

Emergency Phone: 

Doctor: 

Doctor Phone: 

Medical Conditions: Allergies:

IMPORTANT MEDICAL AND LIABILITY RELEASE – MUST BE SIGNED

Recognizing the possibility of injury or illness, and in consideration for the Wisconsin Youth Soccer Association (WYSA), US Youth Soccer and members of US Youth Soccer accepting my son/daughter as a player in the soccer programs and activities of WYSA, US Youth Soccer and its members (the “Programs”), I consent to my son/daughter participating in the Programs. Further, I release, discharge, and otherwise indemnify WYSA, US Youth Soccer, its member organizations and sponsors, their employees, associated personnel, and volunteers, including the owner of fields and facilities utilized for the Programs, against any claim by or on behalf of my player son/daughter as a result of my son’s/daughter’s participation in the Programs and/or being transported to or from the Programs, which transportation I authorize.

My son/daughter has received a physical examination by a physician and has been found physically capable of participating in the Programs. I give my consent to have an athletic trainer and/or doctor of medicine or dentistry provide my son/daughter with medical assistance and/or treatment and agree to be responsible financially for the reasonable cost of each assistance and/or treatment.

I agree that if it appears that my child may have sustained a concussion or head injury that he or she is to be removed from the competition until such time that a trained medical professional can examine them and approve their return to play soccer. In such case, I understand that I am to provide a written clearance for my player to return to play soccer.

Signature: 

Date: