Medical Release Form

MEDICAL RELEASE/PLAYER COMMITMENT FORM
HIGH SCHOOL CUB BASEBALL LEAGUE THIS LEAGUE IS NOT SANCTIONED BY THE IHSAA OR ANY SCHOOL CORPORATION. HIGH SCHOOL COACHES AND BOOSTER CLUBS ARE INVOLVED AT THEIR DISCRETION.
Name: ____________________________
Address:_____________________ Ph# ________________
City/State: ________________________________ Zip ________
Allergies/Health Problems: _____________________________
_____________________________________________________
Grade ___ Birth Date: ____________ Hgt: _____ Wgt: _____
Most recent baseball experience: ________________________
Positions played: ______________________________________
Pitching experince? Y N Catching experience? Y N

TO WHOM IT MAY CONCERN:

This is to certify that as the parent or guardian of (player's name)_______________________________________
a player on the__________________________________________ team, hereby grant permission to the adult
manager, coach, trainer, or business manager of the team to obtain medical care, at my expense, from any licensed
physician, hospital ormedical clinic for the player named herein at such times as either parent or legal guardian
cannot be contacted in person or by telephone. This authorization shall include all activities, including the period
required travel to and from those activities; and we hereby waive, release, absolve, indemnify and agree to hold
harmless the local league, the organizers, supervisors, participants, and persons transporting the player to and from
those activities, for any and all claims arising out of an injury to the player.
We also acknowledge by signing this form that the above named player is committed to playing for only
this team while eligible to play in this league.

Signed ___________________________________________ Date _______________

Relationship _______________________________________

Insurance Company ____________________________________________________

Policy or Certificate Number _____________________________________________

A medical release form, signed by the player's parent or legal guardian MUST be provided, in advance of any participation, for each player on the team in order that physicians and hospitals will accept players for treatment in the event of illness or injury, where the parent(s) or legal guardian are not available. If possible, a photocopy of insurance card should also be provided.