This is a very useful form for travelling teams. Many hospitals will not treat injured players without a medical release from the parents and verification of insurance. If you travel, have this form filled out by every player/parent and take a copy on all your trips.
MEDICAL TREATMENT PERMIT
Due to state and federal hospital regulations, children under the age of 18 may not receive treatment without parental consent. Therefore, your permission is so requested. This form must be signed in the presence of a Notary Public.
______________________________
___________________, as a participating member of the **** baseball team, has my/our permission to receive medical treatment in the event of an injury. This will apply to hospitals and physicians when the team travels.
__________________________________Home Phone: ___________
Parent(s) or Legal Guardian
Business PhoneMother: __________Father: ________________
Subscribed and sworn to before me this _____ day of __________,
My commission expires: _______________________________________
ELIGIBILITY AND MEDICAL INFORMATION
NAME: _________________________________AGE: __________
HOME ADDRESS: _______________________________
_______________________________
DATE OF BIRTH: ____________________
HEALTH INSURANCE CARRIER: _______________ POLICY NUMBER: ________
DOCTORS NAME: _______________DOCTORS BUSINESS PHONE: ___________
DOCTORS ADDRESS:_________________________________________________
ALLERGIES:
MEDICAL ALERTS:
