LITTLE LEAGUE BASEBALL MEDICAL RELEASE FORM

NOTE: To be carried by any Regular Season or Tournament
Team Manager together with team roster or International Tournament affidavit.

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)
If parent(s)/guardian cannot be reached in case of emergency, contact:

Please list any allergies/medical problems, including those requiring maintenance medication. (i.e. Diabetic, Asthma, Seizure Disorder)
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.

FOR LEAGUE USE ONLY:

League Name:______________________________
League ID:________________________________
Division:_________________ Team:______________ Date:______________


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.
 

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