GENERAL RELEASE FORM

I/we hereby acknowledge that participation in soccer competition carries with it potential hazards.  I/we therefore release James Mark Eisenhardt our group leader, team coaches and our chaperones of all liability in the event of injury during the July 5 – July 13, 2013 soccer trip to Spain.

“I/we understand that James Mark Eisenhardt is acting as group leader/coach and all other adults are acting as chaperones, and may as such be permitted to advise my daughter of any breach of local rules, regulations and customs.  Should this occur at any time during the trip, I/we understand that my/our child could be sent home at my/our expense.”

“Signature of parents/guardians and date”

To whom it may concern:

I/we give permission for our daughter __________________________ to travel outside the United States of America with James Mark Eisenhardt, from July 5- July 13, 2013.

_________________________Mother  (and) 

_________________________Father

_________________________Notary _______________Date

To whom it may concern:

We have entrusted ______________________ in the care of our daughter ______________________, with authority to make any emergency decisions regarding care of our child during their soccer trip to Spain July 5 - July 13, 2013.

Emergency Name & Phone#:______________________________________________

Primary Medical Insurance Company:____________________________________

Policy Number:__________________

Allergies or other Medical Conditions:____________________________________

________________________________________________________________________