1 MEDICAL RELEASE FORM I, (Parent/Guardian`s Name) hereby

 MEDICAL RELEASE FORM I,_____________________________ (Parent/Guardian's Name) hereby give permission for any and all medical attention to be administered to my child ____________________________ (Child's Name) In the event of accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I may be contacted. I also assume the responsibility for the payment of any such treatment. This release is effective for the period of one year from the date given below. ADDRESS: ______________________________________________________________________ ______________________________________________________________________ HOME PHONE: ______________________________________________________________________ INSURANCE COMP: ______________________________________________________________________ POLICY NUMBER: ______________________________________________________________________ In case I cannot be reached, any of the following persons is designated to act on my behalf. * COACH: ___________________________________________________ * ASST.COACH:___________________________________________________ * MANAGER: ___________________________________________________ * A league representative where my child is playing. * Any tournament representative where my child is participating in a tournament PHYSICIAN: ____________________________________________________________ ADDRESS: _____________________________________________________________ PHONE: _______________________________________________________________ KNOWN ALLERGIES:____________________________________________________ SIGNATURE (PARENT/GUARDIAN) ________________________DATE __________________ 1