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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
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