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.