Barnegat Bandits Travel Softball
Barnegat Bandits Travel Softball P.O. box 175, Barnegat, nj 08005 [email protected]
Emergency Medical Treatment Form
Name: _____________________________________________________ Date of Birth: _________________ Address: _________________________________________________________________________________ City/State/Zip: _______________________________________________ Home Phone: ________________ Cell Phone: ______________________________________________________________________________ Phones’/Guardian Names: __________________________________________________________________
**** IMPORTANT, PLEASE READ **** I UNDERSTAND THAT THERE IS NO MEDICAL INSURANCE COVERAGE INCLUDED IN THE REGISTRATION FEE. BY PARTICIPATING IN THIS ACTIVITY, YOU ASSUME YOUR OWN MEDICAL INSURANCE RESPONSIBILITIES. PARTICIPANTS OF THE BARNEGAT BANDITS SHOULD RECOGNIZE THAT: CONDITIONS IN AND ABOUT THE PLAYING AND PRACTICING FACILITIES AND THE NATURE OF THE SPORT ALL PRESENT REASONABLE AND UNFORESEEABLE RISK OF INJURY. USERS/PARTICIPANTS ASSUME ALL REASONABLE RISKS, WHICH MAY EXIST, BY VIRTUE OF THE CONDITION EXISTING AT THE FACILITIES, OR BY VIRTUE OF PARTICIPATION IN THE ACTIVITIES. USERS/PARTICIPANTS AGREE TO HOLD HARMLESS THE BARNEGAT BANDITS, ITS ADMINISTRATORS OR VOLUNTEERS IN THE EVENT OF ACCIDENT OR INJURY WHILE PARTICIPATING IN ITS ACTIVITIES AND/OR WHILE USING ANY, AND ALL FACILITIES.
We, the parents of ________________________________, give permission for emergency medical treatment of our child for illness, injury or accident if we cannot be contacted. EMERGENCY CALL LIST: Name _________________________________________________ Phone Number____________________ Insurance Company: _______________________________________ Policy Number: __________________ Childs Physician: ___________________________________ Physician’s Phone Number: _______________ Known Allergies or Physical Limitations: _______________________________________________________ Players Height: _______________ Weight: _______________
Signature: _______________________________________________ Date____________________
VISIT US AT BARNEGATBANDITS.COM FOR MORE INFORMATION
Emergency Medical Treatment Form
Name: _____________________________________________________ Date of Birth: _________________ Address: _________________________________________________________________________________ City/State/Zip: _______________________________________________ Home Phone: ________________ Cell Phone: ______________________________________________________________________________ Phones’/Guardian Names: __________________________________________________________________
**** IMPORTANT, PLEASE READ **** I UNDERSTAND THAT THERE IS NO MEDICAL INSURANCE COVERAGE INCLUDED IN THE REGISTRATION FEE. BY PARTICIPATING IN THIS ACTIVITY, YOU ASSUME YOUR OWN MEDICAL INSURANCE RESPONSIBILITIES. PARTICIPANTS OF THE BARNEGAT BANDITS SHOULD RECOGNIZE THAT: CONDITIONS IN AND ABOUT THE PLAYING AND PRACTICING FACILITIES AND THE NATURE OF THE SPORT ALL PRESENT REASONABLE AND UNFORESEEABLE RISK OF INJURY. USERS/PARTICIPANTS ASSUME ALL REASONABLE RISKS, WHICH MAY EXIST, BY VIRTUE OF THE CONDITION EXISTING AT THE FACILITIES, OR BY VIRTUE OF PARTICIPATION IN THE ACTIVITIES. USERS/PARTICIPANTS AGREE TO HOLD HARMLESS THE BARNEGAT BANDITS, ITS ADMINISTRATORS OR VOLUNTEERS IN THE EVENT OF ACCIDENT OR INJURY WHILE PARTICIPATING IN ITS ACTIVITIES AND/OR WHILE USING ANY, AND ALL FACILITIES.
We, the parents of ________________________________, give permission for emergency medical treatment of our child for illness, injury or accident if we cannot be contacted. EMERGENCY CALL LIST: Name _________________________________________________ Phone Number____________________ Insurance Company: _______________________________________ Policy Number: __________________ Childs Physician: ___________________________________ Physician’s Phone Number: _______________ Known Allergies or Physical Limitations: _______________________________________________________ Players Height: _______________ Weight: _______________
Signature: _______________________________________________ Date____________________
VISIT US AT BARNEGATBANDITS.COM FOR MORE INFORMATION
