Seattle Rainiers

2010 Summer Ball

 Medical Release

TO WHOM IT MAY CONCERN:

This is to certify that I, as the parent or guardian of

 ____________________________________________________________

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 or medical clinic, for the player named herein at such time as either parent or legal guardian cannot be contacted in person or by telephone.  This authorization shall include all league activities, including the period required to travel to and from those activities; and we do hereby waive, release, absolve, indemnify, and agree to hold harmless the Seattle Rainiers Youth Baseball Organization Inc. and 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.

SIGNED____________________________________ Date_____________

RELATIONSHIP TO PLAYER__________________________________

Medical Information

Allergies: ____________________________________________________

Medications: __________________________________________________

Does your child have other medical considerations?

____________________________________________________________

____________________________________________________________

Emergency contacts :( If parents cannot be reached)

Physician ________________________      Phone ___________________

Name ___________________________      Phone ___________________

Name ___________________________      Phone ___________________