Valley Central Youth Football and Cheerleading

Medical Release Form 

All football players and cheerleaders must have this form filled out by their doctor to participate in the Orange County Youth Football League. This completed medical form must be handed in at equipment hand out for football players and team meeting for cheerleaders. 

Orange County Youth Football League Rule: No child will be allowed to practice without this form completed.This form MUST be dated 2010 and turned in by 7/31/10

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Player Name:_______________________________Date of Birth:_______________

 TO BE COMPLETED BY PHYSICIAN

 Height:__________  Weight:__________ Blood Pressure:_______________

 Allergies:____________________________________________________________

 Physical or emotional concerns:_________________________________________

 ____________________________________________________________________

In my opinion, this child is in good health and may participate in tackle football or cheerleading.

 Physician’s  Signature:_____________________________Date:___________

 Physician’s Name:________________________ Phone: _________________  

Address:              _______________________________________