I the undersigned, am the custodial parent / guardian of the athelete named above, and have given consent for him to participate in Youth Basketball sponsored by the Albert Lea Boys Basketball Boosters. In the event he is injured or sick while participating and requires the attention of a physician, I consent to any reasonable medical treatment as deemed necessary by a licensed physician. In the event treatment is called for, which a physician and / or hospital personnel refuses to administer without my consent, I hereby authorize the adult coaching staff to give such consent for us if I cannot be reached by telephone at the one of the numbers listed above, or because of an emergency, there is not time or opportunity to make a telephone call. In the event it becomes necessary for that person to consent for us, I agree to hold the Albert Lea Youth Boys Basketball program and their coaching staff free and harmless of any claims, demands, or suits for damages ariving from giving of such consent so long as the treatment is administered by or under the supervision of a licensed physician. I also acknowledge that I will be ultimately responsible for the cost of any medical care should the health insurance provider not reimburse the cost of the medical care.