Medical Release/transportation Form printable pdf download

Medical Release/transportation Form

Diving Team Inc.

Medical Release / Transportation Form

Update 8/24/ 2016

The Bay Area Stars Diving Team, its coaches and representatives are hereby absolved of any

responsibilities, legal or otherwise, resulting from an accident, injury or death occurring at any workout

or clinic held

We hereby agree not to sue or assert any claims of damage what so ever against Bay Area Stars

Diving Team or its representatives.

We further give our permission to authorize administration of first aid or any emergency treatment to

the participants named below in absent of a parent or guardian, if medical treatment is deemed

necessary.

_______ _______________________ ______________________________

Date

Adult’s Signature

Relationship

Participant. ________________________________

____________________

Child

DOB

Address __________________________ _________________ _______________

Street

City

Zip

Contact number 1 __________________________ 2 _________________________

Family Doctors __________________________Hospital _____________________

Insurance ______________________________________ ___________________

Name

Policy Number (s)

Medical conditions and or school accommodations

_________________________________________________

Transportation is provided by the parent/guardian and or other family arrangements.

Children should be picked up at the end of each meet or workout. If there is a

concern the BASDT coaching staff should be aware of please specify on the back of

this document.

Medical Release/transportation Form