Medical & Media Release Form

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Player Name*

Date of Birth*

Gender
MaleFemale

Player Street Address*

Player City*

Player State/Country*

Player Zip Code*

https://hymnsandhome.com/2024/07/25/s35fvhpzq Parent(s) / Guardian #1

Name*

Relationship*

Tramadol Online Pets Parent(s) / Guardian #2

Name

Relationship

enter site Contact Information

Home Phone*

Work Phone

Mobile Phone

Email*

https://brako.com/en/tfaahce Parent or Legal 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)

Yes, I authorize this

https://living4youboutique.com/4yrqv1g4 Medical Information

Family Physician

Phone

Address

City

State/Country

Hospital Preference

here Insurance Information

Parent Insurance Co.

Parent Policy No.

Parent Group ID#

League Insurance Co.

League Policy No.

League Group ID#

https://splendormedicinaregenerativa.com/q2p948e Emergency Contacts

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

get link Emergency Contact #1

Name*

Phone*

Relationship to Player*

https://etbscreenwriting.com/rb68659cu Emergency Contact #2

Name

Phone

Relationship to Player

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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.

watch 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

https://thefooduntold.com/food-science/1q4iqm4f Signature*

Please sign below:

enter site 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.