LAMAR LITTLE LEAGUE, INC.
MEDICAL INFORMATION/CONSENT TO TREAT
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Family Physician: ________________________________ Phone
No. ______________________________________
Any allergies or medical restrictions?
_________________________________________________________________
In case of an emergency, and a parent/guardian
cannot be reached, please provide an alternate contact person:
Name ___________________________________Relation _____________________Phone No.
________________
I/We, the parents/guardians of the above named candidate for a
position on a Little League@ team, hereby give my/our approval
to participate in any and all Little League@ activities,
including transportation to and from the activities.
I/We know that participation in baseball and softball may result
in serious injuries and protective equipment does not prevent
all injuries to players, and do hereby waive, release, absolve,
indemnify and agree to hold harmless the local Little League@,
Little League Baseball, Incorporated, the organizers, sponsors,
supervisors, participants and persons transporting
my/our child to and from activities for any claim arising out of
any injury to my/our child whether the result of negligence or
for any other cause, except to the extent and in the amount
covered by accident or liability insurance.
I/We do hereby authorize any person in a responsible position
within the Little League@ program, in the event of any
emergency, to authorize emergency medical treatment for my/our
child named herein. I/We agree to hold harmless such persons and
such emergency care centers (hospital, doctors, nurses,
providing such emergency care) for such act and to assume
financial responsibility for said treatment.
I/We will furnish a certified birth certificate of the above
named candidate to Little League@ officials.
| Signature(s): |
Father ________________________________ Date___________________ |
| Mother__________________________________
Date __________________ |
INFORMATION PERTAINING TO YOUR TELEPHONE
NUMBER(S) IN THE LEAGUE DIRECTORY
EACH SPRING, LAMAR LITTLE LEAGUE PUBLISHES A DIRECTORY FOR THE
SOLE USE OF ITS MEMBERS. THIS DIRECTORY IS DISTRIBUTED ONLY TO
LEAGUE MEMBERS. IN ACCORDANCE WITH LITTLE LEAGUE RULES, IT IS
NOT DISTRIBUTED TO PERSONS OR ORGANIZATIONS NOT AFFILIATED WITH
THE LEAGUE. IF YOU DO NOT WANT YOUR PHONE NUMBER(S) TO BE
LISTED IN THE LEAGUE DIRECTORY FOR THE CURRENT SPRING SEASON,
PLEASE CHECK THE BOX AND INITIAL BELOW.
_________I do not want my (our) phone numbers listed in the league
directory for the current spring season.