Deport Baseball Association

Emergency Contact Information
Name of Emergency Contact

First NameLast Name
Phone Number

Area CodePhone Number
Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Relation to Athlete
Confirmation

I hereby declare that I give my full express consent to let my child be given immediate treatment by any personnel in circumstances which may need immediate attendance and care.
Clinic / Hospital
Name of Family Doctor

First NameLast Name

Medical Information
In case the parent/guardian is out of reach at the time of emergency, with consent of the latter, we will exercise the required diligence needed to have the athlete treated by an E.R Physician. In this regard, we would like to get to know any precautions that we need for the athlete.
Any Allergies to Medicine, Antibiotics or any that we need to know?

Parental/Guardian Consent
Waiver

I am aware that any physical sport activity may cause accidental injury or harm among the athletes, and I assume any and all possible risk that may cause injury, illness, or death arising to such activity. I agree to waive my right to pursue any claim against the Deport Baseball Association and anyone affiliated with Deport Baseball Assocation.
Signature of Parent / Guardian

Clear
Name

First NameLast Name
Should be Empty:

Emergency Contact Information