CATARACT LITTLE LOOP
FOOTBALL ASSOCIATION
P.O. Box 223, Niagara Falls, NY 14302
PLAYER INJURY FORM
Name of Player:___________________________ Team:____________________
Address:_________________________________ ( ) Football or ( ) Cheerleading
Phone:_____________________________ Other:________________________
Medical Card #:______________________________ Type:_________________
Birth Date:__________________________
Family Doctor:____________________________ Phone:___________________
Explain ANY Health Problems: allergies, medications, inhalers, etc...
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
_________________________________________________________________
EMERGENCY PHONE NUMBERS
(Please Print)
Name Home Phone
NumberWork Phone
NumberCell Phone
Number1. 2. IMPORTANT: The Parent/Guardian agrees that C.L.L.F.A. and any of its coaches or other officials will not be held responsible for any injury which may occur during games or practice, or en-route to games or practices, or from games or practices.
I fully understand the above clause:
Signature:____________________________________________ Date:___________________
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