Informed Consent/General Release-Youth Baseball Participants



Informed Consent/General Release-Youth Softball Participants

This is a release of liability. Please read carefully before signing.

Since participation in youth sports activities can be dangerous, Sparks Softball WI requires that all participants (and their adult parent(s) or guardians) to assume all risks associated with youth softball by signing this general release.

For and in consideration of my child being permitted to participate in Sparks Softball, youth softball activities, I hereby voluntarily release, discharge, waive and relinquish any and all claims or actions for damages for personal injury, permanent disability, death, or property damage which I or my child may have, or which may here after accrue to me or my child, as a result of my participation in youth softball activities during play and while I am at the any that participates with the organization facility while others play or for any other reason.

This release is intended to discharge, in advance, Sparks Softball, it’s officers, volunteers, employees and agents, and the owners and maintainers of any facility used for softball practice or activities, from any and all liability arising out of or connected in any way with my child’s participation in softball camps/clinic activities, even though that liability may arise out of negligence or carelessness on the part of Sparks Softball, its officers, agents or employees, or the owners or maintainers of any facility used by Sparks Softball, for softball practice or activities.

I further understand that serious accidents occasionally occur during youth softball activities, and that participants occasionally sustain serious personal injuries, death or property damage as a consequence thereof. Knowing the risks, I have voluntarily applied for my child to participate in the activity and thereby agree to assume those risks to release and hold harmless Sparks Softball WI, its officers, volunteers, employees or agents, or the owners or maintainers of any facility used by the Sparks Softball WI, for softball practice or activities, who (through negligence or carelessness) might otherwise be liable to me or to my child (or my heirs or assigns) for damages.

I further understand and agree that this release, discharge, waiver, and assumption of risk is to be binding on my and my child’s heirs, executors, administrators, and assigns.

I further agree to indemnify and to hold harmless Sparks Softball WI, its officers, employees and agents, or the owners or maintainers of any facility used by the Sparks Softball WI, for baseball practices or activities, for any loss, liability damage, cost or expense which may incur as a result of any injury or property damage I or my child may sustain while participating in the activity.

I agree to comply with the program’s stated and customary terms and conditions for participation according to the Sparks Softball WI. If I observe any significant change with regards to my child’s readiness for participation in the program, I will remove my child from the program immediately.

I have read this Informed Consent/General Release, fully understanding its terms, that I give up substantial rights by signing it, and sign it voluntarily.

Child’s Name: __________________________________________________________

Please Print

Signature of Parent/Guardian: ______________________________________________ Date: __________________

This document is a Release of Liability which affects the rights of you and your child. Please read the document carefully before signing.

RELEASE AND HOLD HARMLESS AGREEMENT:

AUTHORIZATION TO SEEK MEDICAL TREATMENT

I, ____________________________________________, being the Parent/Guardian of _________________________________________________________________________,

hereby acknowledge that my daughter is a member of the Sparks Travel Softball Program, and that as a member of said organization, she may be required, at certain times to travel to games and tournaments outside our local geographical area. I HEREBY EXPRESSLY GRANT MY DAUGHTER PERMISSION TO TRAVEL TO AND FROM SAID GAMES AND TOURNAMENTS.

I FURTHER HEREBY EXPRESSLY RELEASE AND HOLD HARMLESS, FOR INJURIES SUSTAINED BY MY DAUGHTER, AFTER THE USE OF ORDINARY AND REASONABLE CARE, THE FOLLOWING PEOPLE OR ENTITIES:

A: SPARKS TRAVEL SOFTBALL PROGRAM, ITS MEMBERS, OFFICERS, AND GOVERNING BODY.

B: THE COACHING STAFF &/OR OTHER SUPERVISORY PARENTS OF MY DAUGHTER’S TEAM.

I FURTHER EXPRESSLY GIVE AUTHORIZATION TO THE COACHING STAFF OF MY DAUGHTER’S TEAM TO SEEK/OBTAIN EMERGENCY MEDICAL CARE FOR MY DAUGHTER, SHOULD MY DAUGHTER BE INJURED, OR BECOME ILL, IN MY ABSENCE.

I HAVE OUTLINED ANY ALLERGIES AND SPECIAL MEDICAL CARE INSTRUCTIONS TO MY DAUGHTER’S COACHING STAFF AS INDICATED BELOW, AND UNDERSTAND THAT IT IS MY DUTY TO PROVIDE MY DAUGHTER AND HER COACHES WITH ANY PRESCRIPTIONS, MEDICATIONS, AND DIRECTIONS THAT MY DAUGHTER MY NEED.

I FURTHER ACKNOWLEDGE THAT IT IS MY DUTY TO PROVIDE THE COACHING STAFF WITH MY DAUGHTER’S HEALTH INSURANCE INFORMATION.

FAMILY DOCTOR_____________________________________________________ PHONE NUMBER________________________

MEDICAL INSURANCE CARRIER _______________________________________________________________________________

INDENTIFICATION NUMBER___________________________________________________________________________________

MEMBER NAME_______________________________________________________________________________________________

ACCOUNT NUMBER___________________________________________________________________________________________

MEDICAL HISTORY:

ALLERGIES, IF ANY, INCLUDING MEDICATION __________________________________________________________________

______________________________________________________________________________________________________________

CHRONIC OR EXISTING DISEASES OR MEDICAL PROBLEMS______________________________________________________

______________________________________________________________________________________________________________

MEDICINES THE PLAYER IS CURRETNLY TAKING_______________________________________________________________

______________________________________________________________________________________________________________

PLEASE ATTACH A COPY OF THE MEDICAL INSURANCE CARD, BOTH FRONT AND BACK

SIGNATURE OF PARENT/GUARDIAN Dated

_________________________________________________________ _______________________________________________________

................
................

In order to avoid copyright disputes, this page is only a partial summary.

Google Online Preview   Download