Waiver and Release of Liability -Medical Consent-Staff Support

Action Baseball Club Waiver and Release of Liability / Medical Consent Staff-Support

NOTE: All Stoff and support participants must read and sign this form before participating in Action Baseboll Events.

In consideration of being allowed to participate in any waywith the Action Baseball program, I, the undersigned acknowledge, appreciate, and agree that:

1.risk bodily injury, including paralysis, dismemberment, disability and death, and while particular rules of sports, skills, equipment and personal discipline may reduce the risk, this risk of serious injury does exist, as well as the risk of damage to or loss of property and,

2.I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others and assume full responsibility for my participation; and,

3.willingly agree to comply with the stated and customary terms and conditions of participation If, however, - observe any unusual significant hazard during my presence or participation or if observe any concern in my readiness for participation, will immediately bring such to the attention of the nearest official and remove myself from participation; and

4.I, for myself, and on behalf of my heirs, assigns, personal representatives, and next of kin, hereby release, indemnify, hold harmless and promise not to sue Action Baseball club, their officers, officials, volunteers, employees, agents, and / or other participants, sponsors, advertisers, and if applicable, the lessors of premises used for the activity ("Releasees"), with respect to any and all injury, disability, death, and/or loss or damage to person or property, whether caused by the negligence of the releases or otherwise, except that which is the result of gross negligence or wanton misconduct, to the fullest extent permitted by law.

I have read this Release of Liability and Walver Agreement, fully understand its terms, understand that have given up substantial rights by signing it, and signit freely and voluntarily without any inducement.

Parent/Guardian Signature *

Clear

Parent/Guardian Name

First Name Last Name

Player’s Name *

Player’s Age *

Player’s Summer 2022 Team

Date *

Date

Parent/Guardian Email *

example@example.com

In the event of an accident or other emergency, Thereby authorize a member of the Action Baseball Staff to make such arrangements as they consider necessary for my medical or hospital care and transportation Under such circumstances, further authorize the physician named below to undertake such care and treatment of my person as he/she considers necessary. In the event the below-named physician is not available, authorize such care/treatment be performed by any licensed physician or surgeon. The undersigned hereby agrees to bear all costs incurred as a result of the forgoing.

Parent/Guardian Signature *

Clear

Date *

Date

Please check any limiting factors that apply.

Wears Glasses

Hearing

Asthma

Diabetes

List Any Allergies

Comments

Home Phone

Cell Phone *

Address, City, Zip *

Emergency Contact Name *

Emergency Contact Phone *

Doctor Name *

Doctor Phone *

Preferred Hospital *

Insurance Carrier

Group Account Number