GENERAL MEDICAL RELEASE FORM

This authorizes representatives of Fielder’s Choice Baseball, Inc. to seek emergency medical care for the below named child. We acknowledge there are risks inherent to the game of baseball and as such, hold harmless Fielder’s Choice Baseball, Inc. and members of its staff and coaching staff from legal action as a result of injuries obtained while participating in events at Fielder’s Choice Baseball, Inc.

Date________________________

Student Information: ____________________________________ Age:_______

Parent / Legal Guardian: ___________________________________________

Signature of Parent or Legal Guardian__________________________________________

In case of emergency, please contact:

Name: _________________________________ Phone:_________________________

Name: _________________________________ Phone:_________________________

Known Allergies to Medication: ___________________________________________________

Email_________________________________________________________________________