Orange County Youth Football

Medical Information Form

All football players and cheerleaders need a note or this form filled out by their own medical professional to

participate in the program.

ORANGE COUNTY YOUTH FOOTBALL & CHEERLEADING LEAGUE RULE:

No child will be allowed to practice without this form completed or a note from a medical professional giving your

child permission to practice football or cheerleading.

**PLEASE LIST ANY ADDITIONAL ALLERGIES OR PHYSICAL CONCERNS THAT WE NEED TO KNOW ON THE BOTTOM OF THIS FORM

FOOTBALL/CHEERLEADER INFORMATION

Player Name: ______________________________________________________________

Date of Birth: ______________________________________________________________

Address: ___________________________________________________________________

Telephone: _________________________________________________________________

TO BE COMPLETED BY MEDICAL PROVIDER

Name of Physician: ______________________________Phone Number: ________________

Allergies: _____________________________________________________________________

Physical or emotional concerns: __________________________________________________

This child is in good health and may participate in football / cheerleading for
the 2024 season..

Signature of Medical Professional: ______________________________Date: _______________________

Medical Stamp: Must be stamped