Madness Medical Release Form 2023-2024 Logo
  • Madness Medical Release Form

  • PLAYER INFORMATION:

  • PARENT/GUARDIAN INFORMATION:

  •  -
  •  -
  •  -
  • EMERGENCY INFORMATION:

  • In case I cannot be reached, any of the following people are designated to act for me:

  • If parents cannot be immediately contacted in case of emergency, contact:

  •  -
  • MEDICAL INFORMATION

  •  -
  • CONCENT:

  • I hereby give permission for any and all medical attention necessary to be administered to my child, (player's name listed above), in the event of an accident, injury, sickness, etc. under the direction of the people listed above until such time as I may be contacted.

    This release is effective for the time during which my child is participating in league play and for all practices and tournaments which her team is participating in during the 2021-2022 season, including traveling to or from practices, league and tournament games. I also hereby assume the responsibility for payment of any such treatments.

  • Should be Empty: