Michigan Sports Academy
Medical Release Form and Parental Permission
I hereby give permission for any and all medical attention necessary to be administered to my child in the event of an accident, injury, sickness, etc., under the direction of the person(s) listed below, until such time as I am contacted.
My child's name is
This release is effective for the time during which my child is participating with Michigan Sports Academy for Lessons, Training, Camps and Summer Teams. This includes games, practices, conditioning sessions related to the program (which begins January 2026 and runs through August 2026). This also includes travel to and from such events. I will assume the responsibility for payment related to any such treatment that may occur.
PARENT / GUARDIAN INFORMATION (if participant is a minor)
Parent/Guardian Name:
Phone:
Format: (000) 000-0000.
EMERGENCY CONTACT INFORMATION
Emergency Contact Name:
Phone:
Format: (000) 000-0000.
MEDICAL INFORMATION
Doctor Name:
Phone:
Format: (000) 000-0000.
Insurance Company:
Insurance Policy #:
Do you have any medical conditions we should be aware of?
Diabetes
Asthma
Food Allergies
Other
If yes, please explain:
PARENTAL PERMISSION AND WAIVER OF LIABILITY
I understand that baseball/softball are dangerous activities that may result in very serious injuries or death, including but not limited to injuries caused by being hit with a baseball/softball or bat, player collisions, physical stress from exertion and accidents due to outdoor conditions or other unforeseen matters. My child (or ward) is in good physical and mental health, such that he/she is capable of playing baseball/softball without undue risk. I understand that there may not be trained medical personnel at the Michigan Sports Academy program. I will assume all risks associated with my child's participation. These risks include injury, loss or damage he/she may suffer related to practicing and playing in this Michigan Sports Academy program. For myself and my heirs, legal representatives and assigns, I waive, release and give up, and will not directly, or indirectly, bring any action for, any and all claims, demands and possible lawsuits related to practicing, workouts, games and travel that I may have now or in the future against Harrison's MSA Instruction, MSA Instruction, LLC, MSA Instruction, Inc, Saline Schools and any coaches, employees, officials and volunteers in the Michigan Sports Academy Program.
Parent/Guardian Initials (Parental Permission):
Concussion and Head Injury Acknowledgment
I understand that participation in baseball, softball, and sports performance training may result in head injuries or concussions. I acknowledge that concussions are serious injuries that may result in short- or long-term effects. I agree that if my child exhibits signs or symptoms of a concussion, he or she may be removed from participation and may not return to activity until cleared by a qualified medical professional. I accept full responsibility for monitoring my child's condition and complying with all return-to-play requirements.
Parent/Guardian Initials (Concussion Acknowledgment):
Photo and Video Release
I grant Michigan Sports Academy the irrevocable right and permission to photograph, videotape, record, or otherwise capture my child's likeness, image, voice, or performance during training, activities, or events. I authorize the use of such media for promotional, marketing, educational, social media, website, and advertising purposes without compensation. I waive any right to inspect or approve the finished product and release Michigan Sports Academy from any claims arising from the use of such media.
Parent/Guardian Initials (Photo Release):
SIGNATURES
Parent or Guardian Signature
Date:
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Month
-
Day
Year
Date
Michigan Sports Academy - Confidential
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