I hereby give my permission for treatment of my child for accident by stephan2

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									I hereby give my permission for treatment of my child for
accident or injury encountered during any scheduled
Cinderella activity. This includes practices, games, picnics, etc.

Player: _______________________________ Date of Birth: ____________


Family Physician: _______________________ Phone: _______________
Address:
____________________________________________________________


Hospital Preference:
__________________________________________________


In case of emergency contact:
_____________________________________________________________
Name Phone Relationship to Player
_____________________________________________________________
Name Phone Relationship to Player




________________________________________________________
Authorized Parent/Guardian Signature

								
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