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SILICON VALLEY BASEBALL/SOFTBALL ASSOCIATION

MEDICAL RELEASE FORM

This is to certify that I, parent/guardian of _______________________________________,


a player on the Silicon Valley Glory, hereby grant permission to the adult manager, coach or
business manager of the team, to obtain medical care from any licensed physician, hospital,
medical clinic, for the player named herein, at such times as either parent or legal guardian
cannot be contacted in person or by telephone. This authorization shall include all team
activities, including the period required to travel to and from those activities; and we do
hereby waive, release, absolve, indemnify, and agree to hold harmless Silicon Valley Glory
Baseball/Softball Association; the organizers, supervisors, coaches, participants, and persons
transporting the players to and from those activities, from any claim arising out of an injury to
a player.
Date of birth _______/_______/_______

Physical Limitations ________________________________________________

Medical Conditions ________________________________________________

Medications ________________________________________________

Allergies ________________________________________________

Personal Physician __________________________phone:__________________

Parent/Guardian ________________________________________________________

Address ________________________________________________________

________________________________________________________

Home phone: ________________________

Mom/cell:__________________ Dad/cell:________________Other/cell:_________________

Email address(es)______________________________________________________________

Signature:______________________________________ Date:_________________________
SILICON VALLEY BASEBALL/SOFTBALL ASSOCIATION
HOLD HARMLESS & LIABILITY WAIVER

In consideration of my childs participation as a member of the SILICON VALLEY GLORY, I agree


to hold harmless and waive any and all liability, and claims against the SILICON VALLEY
BASEBALL ASSOCIATION and their boards, agents, employees, managers, coaches, parents,
opponents and against any and all facilities which may be utilized for practices or games in
which physical injuries may occur from participation in any activity which is affiliated with this
team. I understand, appreciate and accept such risk on behalf of my minor child and myself. I
acknowledge that it is a privilege and honor to participate on this team and that any future
consideration of participation on this team shall be at the sole discretion of the team manager.

PLAYERS NAME:______________________________________________________

PLAYERS SIGNATURE (if 18 or over):______________________________________

PARENTS NAME:______________________________________________________

PARENTS SIGNATURE:__________________________________________________

DATE:________________________