PONY BASEBALL AND SOFTBALL
MEDICAL RELEASE FORM
TO WHOM IT MAY CONCERN:
This is to certify that as the parent or guardian of (please insert the child’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 or medical clinic for the player
named herein at such times as either patent or legal guardian cannot be contacted in person or by telephone.
This authorization shall include all activities, including the period required to travel to and from those activities;
and we hereby waive, release, absolve, indemnify and agree to hold harmless the local PONY Baseball and Softball organization,
PONY baseball, Inc., 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.
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 tournament 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.
PONY Baseball and Softball