FCT Waiver and Release Form

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FCT Waiver and Release Form

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* Indicates required question

Email *

Your email

Team Name *

Your answer

Team Division *

U10

U12

U14

JV

Varsity

Player Last Name *

Your answer

Player First Name *

Your answer

Player Date of Birth *

MM

/

DD

/

YYYY

Parent or Guardian Name *

Your answer

Emergency Contact Phone Number *

Your answer

Zip Code *

Your answer

FCT Waiver & Release Form

By Clicking "I agree" - You acknowledge, agree to and understand the FCT Waiver and Release Form as well as the Concussion Information Sheet *

I agree

Required

Today's Date *

MM

/

DD

/

YYYY

Time of Date *

Time

:

AM

PM

Send me a copy of my responses.

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