Medical Release Form

Email Secondary Email

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Email address *

I/we hereby authorize Team Connecticut Baseball and its coaches/staff to act in my/our behalf in obtaining emergency medical treatment for my/our son if I/we are unable to do so ourselves.

Player Name: *

Team/Age: *

Insurance Coverage:

Insurance Number:

Primary Doctor:

Doctor's Phone Number:

Mother's Name: *

Mother's Cell Phone: *

Father's Name: *

Father's Cell Phone: *

Parent/Guardian Signature: *

Typing in my name serves as my signature acknowledging that my son's participation in Team Connecticut Baseball activities is potentially hazardous and can cause bodily injury or death. I clearly understand that, by signing this form and/or my son's involvement in Team Connecticut Baseball activities, I assume all risk for any injury resulting therefrom.

Date Signed: *

Date Picker

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