Medical & Media Release Form

go here Please fill out the following Medical & Media Release Form for any players participating in Yarmouth Little League. Required fields are noted with a star (*). Please include a signature at the bottom by signing with your cursor (desktop) or finger (mobile).

follow url Player Information

https://emduk.org/4lutwdx77g Player Name*

source Date of Birth*

https://restoreredspruce.org/2024/05/13/go46m9uqefh Gender
MaleFemale

see Player Street Address*

go site Player City*

click Player State/Country*

https://dentaris-sa.com/2024/05/13/b4ymkf5g Player Zip Code*

https://yplocal.us/9abaryrn64i Parent(s) / Guardian #1

https://annmorrislighting.com/vmq42ast Name*

Buy Alprazolam Online Overnight Relationship*

follow url Parent(s) / Guardian #2

get link Name

Buy Diazepam Online Uk Relationship

go site Contact Information

Buy Xanax Las Vegas Home Phone*

https://someawesomeminecraft.com/2024/05/13/mmox16gu49i Work Phone

https://domainebregeon.com/zfqar7dx Mobile Phone

https://aaerj.org.br/2024/05/13/3l4xbb3i2 Email*

follow url Parent or Legal Guardian Authorization*

https://photovisions.ca/sa83tdj9 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)

https://www.vertaglia.com/bny8gjiv61 Yes, I authorize this

enter Medical Information

https://discovershareinspire.com/2024/05/78leox6rymf Family Physician

Phone

Address

City

State/Country

Hospital Preference

https://pkuatm.org/2024/05/13/7e8m57sdy Insurance Information

Parent Insurance Co.

Parent Policy No.

Parent Group ID#

League Insurance Co.

League Policy No.

League Group ID#

follow site Emergency Contacts

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

https://domainebregeon.com/63cma8pari Emergency Contact #1

Name*

Phone*

Relationship to Player*

https://dentaris-sa.com/2024/05/13/0rat2ul Emergency Contact #2

Name

Phone

Relationship to Player

https://discovershareinspire.com/2024/05/1mqy45u5 Medications

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

Medical Diagnosis

Medication

Dosage

Frequency of Dosage

Date of Last Tetanus Toxoid Booster

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.

Buy Xanax Cod Delivery Media Release*

By checking the box below, I hereby give my permission to use photographs, voice recordings, or video taken of the Player during the games and events associated with Yarmouth Little League in any manner to help promote the league activities as determined in the sole discretion of Yarmouth Little League. Such use could include publications, media releases, public announcements, electronic or otherwise, and on league websites or social media pages. I agree that neither I, nor the Player, will receive any compensation if such image appears in any of the manners listed above or other manner that Yarmouth Little League deems appropriate. I agree that such image is the property of Yarmouth Little League.

Yes, I authorize this

go here Signature*

Please sign below:

https://templedavid.org/symons/83k2eke 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.