Medical Information & Waiver Forms
This packet contains medical information forms and a sample waiver and release from liability form. In today's
climate of insurance claims and liability action, the use of these forms is mandatory by your club and/or league.
Parent's Medical Instructions
This form can give your club coach or administrator instructions on how to proceed if an athlete becomes injured or
ill and needs emergency treatment.
Medical History Questionnaire
If you are traveling and one of your athletes needs medical attention, this information can be of great value to an
The parent's Medical Instruction and the Medical History Questionnaire for each athlete should be kept in a sealed
envelope with his name on the outside in or with the club's medical kits. It is recommended that the kit also should
have a list of emergency phone numbers for each club member, along with the standard 911, police, ambulance,
fire, etc., phone numbers.
Participant's Waiver and Release From Liability Form
This form provides the club administration a copy of a standard participant's waiver and release from liability form.
It is mandatory that club administrators have this form signed in addition to the form attached to the membership
card. Failure to obtain a waiver and release on members will result in a loss of insurance coverage.
Please keep medical forms for no less than 18 months.
You must keep all Waiver and Release forms for 7 years.
PARENT'S INSTRUCTIONS ON MEDICAL TREATMENT
PLEASE PRINT IN CAPITAL LETTERS
Date of Birth
Please indicate another person to call it an accident occurs and we are unable to reach you: