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    Medical Release Form

    Uploaded by

    Jennifer Jwow Pagán
    Little League does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference. Medical release form must be carried by any Regular Season or Tournament Team Manager together with team roster or eligibility affidavit.

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    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd

    Medical Release Form

    Uploaded by

    Jennifer Jwow Pagán
    112 views1 page
    Little League does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference. Medical release form must be carried by any Regular Season or Tournament Team Manager together with team roster or eligibility affidavit.

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    © Attribution Non-Commercial (BY-NC)

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    Little League does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference. Medical release form must be carried by any Regular Season or Tournament Team Manager together with team roster or eligibility affidavit.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    112 views1 page

    Medical Release Form

    Uploaded by

    Jennifer Jwow Pagán
    Little League does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference. Medical release form must be carried by any Regular Season or Tournament Team Manager together with team roster or eligibility affidavit.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    of 1

    Fill Out Online and Print For Signature

    Little League®
    Baseball and Softball
    Medical Release
    NOTE: To be carried by any Regular Season or Tournament Team
    Manager together with team roster or eligibility affidavit.

    Player: ______________________________________ Date of Birth: ____________

    League Name: ________________________________ I.D. Number: ____________

    Parent or Guardian Authorization:

    In case of emergency, if family physician cannot be reached, I hereby authorize my child


    to be treated by Certified Emergency Personnel. (i.e. EMT, First Responder, E.R. Physician)

    Family Physician: ______________________________ Phone: _______________

    Address: ____________________________________________________________

    Hospital Preference: __________________________________________________

    In case of emergency contact:

    ___________________________________________________________________
    Name Phone Relationship to Player

    ___________________________________________________________________
    Name Phone Relationship to Player

    Please list any allergies/medical problems, including those requiring maintenance


    medication. (i.e. Diabetic, Asthma, Seizure Disorder)

    Medical Diagnosis Medication Dosage Frequency of Dosage

    The purpose of the above listed information is to ensure that medical personnel
    have details of any medical problem which may interfere with or alter treatment.

    Date of last Tetanus Toxoid Booster: _____________________________________

    Mr./Mrs./Ms. ________________________________________________________
    Authorized Parent/Guardian Signature
    WARNING: Protective equipment cannot prevent all injuries a player might receive while participating in Baseball/Softball.

    Little League does not limit participation in its activities on the basis of disability,
    race, color, creed, national origin, gender, sexual preference or religious preference.

    my documents/tournaments/2007/medical release form rev. 2/05.1

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