PLAYER SAFETY & CONSENT

Medical Release

Complete and sign this form for your player. A PDF copy will be securely stored and emailed to the organization.

Player information

Player full nameDate of birthSeasonTeamPlayer addressHome phoneMobile phone

Parent or guardian

Parent/guardian nameRelationshipSecond parent/guardianRelationshipEmail for completed copy

Medical authorization

In case of emergency, if the family physician cannot be reached, I authorize my child to be treated by certified emergency personnel, including an EMT, first responder, or emergency-room physician.

Family physicianPhysician phonePhysician addressHospital preferenceParent insurancePolicy numberGroup ID

Emergency contacts

Emergency contact namePhoneRelationshipSecond contact namePhoneRelationship

Allergies, diagnoses, and medications

List all allergies, medical problems, medications, dosages, and frequency

Date of last tetanus booster

Authorization and release

The purpose of this information is to ensure medical personnel have details of any medical problem that may interfere with or affect treatment.

I understand that participation in baseball may result in serious injuries and that protective equipment does not prevent all injuries. I waive, release, absolve, indemnify, and agree to hold harmless the Beehive Baseball Organization, its organizers, sponsors, supervisors, participants, and persons transporting my child to and from activities from claims arising from injury to my child, whether resulting from negligence or another cause.

I am the player’s authorized parent or guardian, and I agree to the medical authorization and release above.

Type full legal name as signatureDate signed