Player Profile

What Church does the Player Attend? (If none, write none):
Valley Vinyard
What School does the Player Attend?
Ivy Academia
Health Insurance Provider:
Blue Cross
Policy #:
Family Physician:
Dr. Auerbach
Physician Phone #:
I hereby authorize Valley Christian Athletic Association to provide proper medical care for my child as they deem necessary; such as but not limited to, call 9-1-1, bring my child to the nearest emergency room or urgent care, apply ice, apply bandage:
I Agree

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