MEDICAL RELEASE FORM


I,_____________________________ (Parent/Guardian's Name) hereby give permission for

any and all medical attention to be administered to my child ____________________________ 

(Child's Name) In the event of accident, injury, sickness, etc., under the direction of

the person(s) listed below, until such time as I may be contacted.  I also assume the

responsibility for the payment of any such treatment. This release is effective for

the period of one year from the date given below.

ADDRESS:            ______________________________________________________________________

.                   ______________________________________________________________________

HOME PHONE:         ______________________________________________________________________

INSURANCE COMP:     ______________________________________________________________________
 
POLICY NUMBER:      ______________________________________________________________________


In case I cannot be reached, any of the following persons is designated to act on

my behalf.

     * COACH:          ___________________________________________________

     * ASST.COACH:___________________________________________________

     * MANAGER:     ___________________________________________________

     * A league representative where my child is playing.

     * Any tournament representative where my child is participating in a tournament

PHYSICIAN: ____________________________________________________________

ADDRESS: _____________________________________________________________

PHONE: _______________________________________________________________

KNOWN ALLERGIES:____________________________________________________

SIGNATURE (PARENT/GUARDIAN) ________________________DATE  __________________

Subscribed and sworn before me,

this ______ day of __________________ , 200_

________________________________________________
Notary Public