Sudbury Youth Basketball League
 Active Youth are Healthy and Happy Youth

SYBL WINTER LEAGUES

Medical Release

 

SYBL – MEDICAL RELEASE FORM

(Please complete form legibly)

 

I hereby give permission for any and all medical attention necessary to be administered to (athlete)                                                                in the event of an accident, injury, sickness, etc., under the direction of the people listed below until such time as I may be contacted.

 

The release is effective for the time during which my child is participating in the SYBL League offered during the Fall Session at various locations.

 

Parents Name(s):                                                                                         


Home Phone:


Cell:                                                        


Health Card #:                                                                                                                  

 

Child’s Allergies:                                                                                                                                            

 

Additional Medical Condition(s) that the coach should know about?

 

 

 

 

 

 

 

 

 

IN CASE I CAN NOT BE REACHED, EITHER OF THE FOLLOWING PEOPLE IS DESIGNATED


Name


Phone Number                                                 


 

Name                                                                 Phone Number                                           

 

 

I parent/guardian, hereby waive any or all rights, claims for damage arising from injury received while my child is playing or participating in games or other activities.

I also give permission for the SYBL League to use my child’s picture for advertising purposes such as flyers or brochures.

 

Signature of Parent/Guardian                                                               Date