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Get Soccer Player Clearance Letter Pdf Template

AMERICAN YOUTH FOOTBALL Medical Clearance Form S.M. A. A. ASSOCIATION NAME - I hereby my signature below do certify that I am licensed by the state and am qualified in determining that Childs Name is physically fit and I have found no medical or observable conditions which would contra-indicate him/her from participating in youth flag football tackle football cheer dance step or athletic activities. It will also be the responsibility of the Parent / Legal Guardian to obtain WRITTEN permission from his/her physician to resume participation. A Doctors Resume Participation Medical Clearance Form is available from the league or you may have the doctor supply his/her own WRITTEN Clearance as long as it is on the doctor s official stationary and includes the following statement Participants Name is physically fit and I have found no medical or observable conditions which would contra-indicate him/her from participating in youth flag football tackle football cheer dance step or athletic activities. I am therefore clearing this individual for athletic participation* Please Print - or - Use Office Stamp Here Signature Print Name Clearly Date / / Office Address Must be dated after January 1st of the Current Season PLEASE NOTE If this Medical Clearance is voided by injury accident or illness it will be the Responsibility of the Parent/Legal Guardian to notify the participants Coach and League Officials. I am therefore clearing this individual for athletic participation. This statement must be supplied by the physician attending to the injury accident or illness. This form can be modified or substituted ONLY to comply with local and/or state laws or due to medical practitioner regulations. Has athlete had the following Explain YES answers. Injuries to head neck bones or joints YES Any other injuries requiring medical attention YES Seizures blackouts or any episode of unconsciousness YES Heart trouble heart murmur high blood pressure YES Any serious infectious disease YES NO Hospitalization or operations in the past YES Stomach intestinal or urinary tract problems YES Is athlete currently under care of a doctor YES NO Is athlete taking any medication on a regular basis YES NO 10. I am therefore clearing this individual for athletic participation. This statement must be supplied by the physician attending to the injury accident or illness. This form can be modified or substituted ONLY to comply with local and/or state laws or due to medical practitioner regulations. This form can be modified or substituted ONLY to comply with local and/or state laws or due to medical practitioner regulations. Has athlete had the following Explain YES answers. Injuries to head neck bones or joints YES Any other injuries requiring medical attention YES Seizures blackouts or any episode of unconsciousness YES Heart trouble heart murmur high blood pressure YES Any serious infectious disease YES NO Hospitalization or operations in the past YES Stomach intestinal or urinary tract problems YES Is athlete currently under care of a doctor YES NO Is athlete taking any medication on a regular basis YES NO 10.

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