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Get NCYSA Medical Consent /Waiver of Liability and Release 2011-2024

Lectible insurance. If there is no primary insurance on a player, this policy is primary after the deductible. PO Box 29308 Greensboro, NC 27429 336.856.7529 Player First Name M Initial Last Name ( AS APPEARS ON BIRTH CERTIFICATE) Full Association Name (no acronym) [ ] Academy [ ] Challenge [ ] HS Challenge Birth Date [ ] Classic [ ] Recreation Jersey # [ ] Male Level [ ] Female Gender Address of Player City State Zip Parent/Legal Guardian Full Name Home Phone Work Phone Cel.

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