Parental Release Form printable pdf download

Parental Release Form

I wish for my child (list all)

to participate in the Winsted Youth

Baseball & Softball program this summer. I understand accidents and injuries may occur due to the

nature of the game. I agree to take full responsibility for all cost resulting from such injuries. I

understand that all parties associated with this program are volunteers, and will release them, the City

of Winsted, and the Winsted Youth Baseball and Softball Association from all claims to rights to damages

for injuries and/or losses suffered by me or my child, whether by training, attendance in or traveling to

and from this practice/game, and further I state that I have adequate health and accident insurance to

I give the coaches permission

cover any injuries or sickness incurred during this practice/game.

to take my child in for medical treatment if required.

Parental Signature___________________________Date________________

Insurance Company____________________ Policy #____________________

Are there any health problems your child’s coach should be aware of?

In case of an emergency,

and I can’t be reached, contact:

Name

Name _ _____

Phone

Address

Parental Release Form