MEDICAL INFORMATION AND RELEASE FORM

                                                Please read carefully before signing!

Participant’s Name _________________________   Ph. # _____________

Age _____ Date of Birth ___________

Address __________________________________________

City/State/ZIP_______________________________

Parent/Guardian Name_______________________________               

Parent’s Work or Other Ph.# ___________________

                                                    Important Medical Information:

Emergency Contact (Other than parents) _________________________________         
Emergency Contact Ph. # ______________________

Is the participant taking medication?  Yes or No           
If yes, what is the medication? _________________________

How often is this medication taken? _____________
What is the purpose of this medication? __________________

Is the participant allergic to anything and what? ______________________________________________________

Are there any physical limitations, special circumstances or other information we should be aware of?

________________________________________________________________________________________________________

I, the undersigned, the parent or guardian of ____________________________, a minor, do hereby approve my child’s participation in All Star Sports Academy, L.L.C., and its sponsored activities.  I hereby consent and acknowledge that my child will be subject to and shall assume the ordinary risks of such sponsored activities, including, but not limited to, baseball activities.

I further agree to hold harmless and release All Star Sports Academy, L.L.C., its employees, staff members, agent, contractors and anyone associated with any activities sponsored by All Star Sports Academy, L.L.C., from any and all liability arising from such activities.  I further agree to hold harmless and indemnify All Star Sports Academy, L.L.C., from any and all demands, claims and suits arising from such activities, including all judgments, costs and expenses, including attorney fees.

You must sign below or, if under the age of 18 years, the parent or guardian of the participant must sign.

I hereby certify I have read the foregoing and do hereby agree to abide and be bound by its terms, on behalf of my child, and on behalf of myself.

Parent’s or Guardian’s Signature                                             Child’s Name                                         Date