Parent / Guardian Waiver — CMH Soccer Academy

Section A — Player & Parent Information

Player Name:

Date of Birth:

Parent/Guardian:

Relationship:

Phone:

Email:

Home Address:

Emergency Contact:

Emergency Phone:

Section B — Medical Information

Known allergies:

Medical conditions:

Current medications:

Primary physician:

Insurance provider:

Section C — Acknowledgment of Risk

I, the undersigned parent/legal guardian of the named minor, acknowledge that participation in soccer training involves inherent physical risks including but not limited to: bruises, sprains, strains, fractures, contact injuries, heat exhaustion, and other risks ordinary to athletic activity. I confirm my child is medically able to participate.

Section D — Release of Liability

In consideration for being permitted to participate in CMH Soccer Academy programs, I hereby release, waive, and discharge Carlos Moreno Henao individually, CMH Soccer Academy, and any associated coaches or facilities, from any and all liability, claims, demands, or causes of action arising from my child's participation, except in cases of gross negligence or willful misconduct.

Section E — Medical Emergency Authorization

In the event of a medical emergency where I cannot be reached immediately, I authorize the Academy or its representatives to seek emergency medical treatment for my child, including transport to a hospital. I understand I am responsible for any medical costs incurred.

Section F — Photo / Video Consent (Opt-In)

I CONSENT to my child being photographed or recorded during sessions, and to those images being used for the Academy's instructional materials, social media (without revealing my child's full name), and website. I may revoke this consent in writing at any time.

I DO NOT CONSENT to any photo or video usage of my child by the Academy.

Section G — Code of Conduct

I have read and agree to the Academy's expectations of respectful, sportsmanlike conduct by players and family members at all sessions. I understand that abusive or disruptive behavior may result in suspension or termination of services.

By signing below I confirm that I have read and understood this entire document. I am the legal parent or guardian of the minor named above. The information provided is accurate. I agree to all terms herein, including the release of liability in Section D, medical emergency authorization in Section E, and (per my checkbox selection) the photo/video provisions in Section F.

Parent / Legal Guardian Signature

Date

Printed Name

Witness Signature (optional)

CMH SOCCER ACADEMY

Parent / Guardian Waiver
& Consent Form

Section A — Player & Parent Information

Section B — Medical Information

Section C — Acknowledgment of Risk

Section D — Release of Liability

Section E — Medical Emergency Authorization

Section F — Photo / Video Consent (Opt-In)

Section G — Code of Conduct

CMH SOCCER ACADEMY

Parent / Guardian Waiver& Consent Form

Section A — Player & Parent Information

Section B — Medical Information

Section C — Acknowledgment of Risk

Section D — Release of Liability

Section E — Medical Emergency Authorization

Section F — Photo / Video Consent (Opt-In)

Section G — Code of Conduct

Parent / Guardian Waiver
& Consent Form