Southern California Municipal Athletic Federation (Scmaf) Minor Release Form And Consent For Treatment
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1SOUTHERN CALIFORNIA MUNICIPAL ATHLETIC FEDERATION
(SCMAF)
PLEASE PRINT
MINOR RELEASE FORM AND CONSENT FOR TREATMENT
CHILD’S NAME: ______________________________________________________________
First
Last
MALE ____
FEMALE _____
DATE OF BIRTH: ____/____/____
NAME OF PARENT OR GUARDIAN: _________________________________________________________________________
First
Last
ADDRESS: ___________________________________________________________________________________________________
City
State
Zip
HOME PHONE: _______________________________________ BUSINESS PHONE: _________________________________
ACTIVITY: ___________________________________________________________________________________________________
RELEASE
I give permission for the minor in my custody to participate in the above-mentioned activity and hereby waive, release and discharge any and
all claims or rights to claims for damages for death, personal injury or property damage which I may have, or accrue to me, as a result of said
minor’s participation in said activity. This Release is intended to discharge in advance the promoters, sponsors, the Southern California
Municipal Athletic Federation (SCMAF), the officials, and any involved municipalities or other public entities (and their respective agents and
employees), from and against any and all liability arising out of or connected in any way with said minor’s participation in said activity, even
though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above.
I further understand that serious accidents occasionally occur during said activity, and that participants in such activity occasionally sustain
mortal or serious personal injuries, and/or property damages, as a consequence thereof. Knowing the risks of said activity, nevertheless, on
behalf of said minor child, I hereby agree to assume those risks and to release and hold harmless all of the persons or entities mentioned
above who, through negligence or carelessness, might otherwise be liable to me, or my heirs or assigns for damages.
It is further understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns. It is further
understood and agreed that this waiver, release and assumption of risk is to be binding on my heirs and assigns.
I agree to accept and abide by the rules and regulations of the Southern California Municipal Athletic Federation.
___________________________________
___________________________________________________________________
Date
Signature of parent or guardian
CONSENT TO TREATMENT OF MINOR
*In the event of sudden illness, accident or injury which may occur while said minor is engaged in an activity supervised by the Southern
California Municipal Athletic Federation and their representatives, agents or assignees, when neither the parents, guardian or designated family
physician can be contacted, I hereby give my consent pursuant to California Civil Code #25.8 for emergency treatment as shall be necessary
under the circumstances by any physician licensed under the Laws of the State of California.
___________________________________
_______________________________________________________________________________
Date
Signature of parent or guardian
Family Physician: ________________________________________________________________________________________________
Telephone: _____________________________________________________________________________________________________
Insurance Co.: _______________________________________
Type of Coverage: _________________________________________
Pertinent medical history information (Epilepsy, Diabetes, Allergies, etc.) ____________________________________________________
_______________________________________________________________________________________________________________
Emergency Numbers: 1. Name ____________________________________ Phone __________________________________________
(other than parents) 2. Name ____________________________________ Phone __________________________________________
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