Medical Release Form

A parent or legal guardian must complete this Medical Release Form for each player participating in FC Bosna activities. This form authorizes emergency medical treatment and provides essential health information to our coaching staff. Please fill out all sections completely.

📄 Download Printable PDF Version

🏥 FC Bosna Medical Release & Authorization

FC Bosna • Manchester, NH

1 Health Certification

I hereby certify that the above-mentioned participant is in good health and fully able to participate in all activities of FC Bosna, including but not limited to:

Training sessions, practices, scrimmages, and conditioning
League games, tournament matches, and friendly competitions
Soccer camps, clinics, and skills development programs
Indoor and outdoor activities at all designated facilities

I confirm that the participant has no known medical conditions that would prevent safe participation, or that any existing conditions have been disclosed in the medical information section below and have been cleared by a physician.

2 Release of Liability

I agree that FC Bosna, its directors, coaches, trainers, volunteers, and affiliated organizations will not be held responsible for any accident, injury, or loss to the participant however caused. I hereby release FC Bosna from all claims or damages which may arise from any accident, injury, or loss sustained during participation in any FC Bosna activity.

This release applies to all FC Bosna facilities, training locations, and any off-site venues used for games, tournaments, or events.

3 Emergency Medical Authorization

I consent to have the administrators and coaching staff of FC Bosna act on my behalf should any emergency arise. I hereby grant permission to said administrators to:

Authorize emergency medical attention as recommended by a physician, nurse, or hospital
Transport the participant to a medical facility if necessary
Administer basic first aid as appropriate
Contact emergency medical services (911) in the event of a serious injury or medical emergency

I understand that FC Bosna will make reasonable efforts to contact me or my designated emergency contacts before seeking treatment. I am responsible for any and all medical expenses incurred on behalf of my child.

4 Photo & Video Release

I hereby grant to FC Bosna the right to use and publish photographs and video recordings taken during training sessions, games, camps, clinics, and other club events involving the above-mentioned participant. These materials may be used for:

Editorial, advertising, and web use
Club social media, website, and newsletters
Promotional materials and community outreach

📋 Medical Release Form

Please complete all fields below. Fields marked with * are required.

Website

⚽ Player Information

Player Full Name *

Date of Birth *

Age *

Phone

Team / Program *

Address *

City & Zip Code *

👤 Parent / Guardian Information

Parent/Guardian Full Name *

Email Address *

Phone Number *

Relationship to Player *

🚑 Emergency Contact #1

Contact Name *

Relation to Player *

Daytime Phone *

Evening Phone

🚑 Emergency Contact #2

Contact Name *

Relation to Player *

Daytime Phone *

Evening Phone

🏥 Medical Information

Important: Please provide accurate and complete medical information. This information is critical for the safety of your child and will be shared only with coaching staff and emergency medical personnel as needed.

Allergies *

Drug Sensitivity or Allergy

Seizure Disorder

Asthma

Orthopedic Injuries or Disorders

Chronic Medical Problems

Current Medications

Special Health Concerns

🛡️ Insurance Information

Medical Insurance Company *

Policy Number *

👨‍⚕️ Physician Information

Physician Name *

Physician Phone *

📝 Agreement & Electronic Signature

I certify that the above-mentioned participant is in good health and fully able to participate in all activities of FC Bosna, including practices, games, camps, clinics, and tournaments.

I agree to the Release of Liability and understand that FC Bosna and its staff will not be held responsible for any accident or loss to the participant.

I grant Emergency Medical Authorization and give permission to FC Bosna staff to authorize medical attention as recommended by a physician, nurse, or hospital in case of emergency.

I grant Photo & Video Release permission for editorial, advertising, and web use.

I confirm that all medical information provided above is accurate and complete. I will notify FC Bosna of any changes to my child's medical condition.

I understand that I am responsible for all medical expenses incurred on behalf of my child and that FC Bosna does not carry medical insurance for individual participants.

Electronic Signature (Type Full Legal Name) *

Date Signed

I confirm that my typed name above constitutes my electronic signature and has the same legal effect as a handwritten signature.

⚖️ Legal Disclaimer: This medical release form is provided as a standard protective document for youth soccer participation with FC Bosna (Manchester, NH). It is intended to authorize emergency medical treatment and provide essential health information to coaching staff. This document does not constitute legal or medical advice. FC Bosna recommends consulting with a qualified physician regarding your child's fitness for athletic activity. By signing, you acknowledge that you have read, understand, and agree to the contents of this medical release form in its entirety.