Make your own free website on Tripod.com
Home | NY Clash Summer Bash | 18U | 16U | 14U Purple | 14U White | Weather | Directions | Medical Release

NY Clash Girls Fastpitch Softball

Medical Release

OFFICIAL

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.

 

SIGNED__________________________________________

RELATIONSHIP___________________________________

DATE_____________________________________________

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 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.

Abraham Key

President/CEO

PONY Baseball and Softball