Clear Form PHONE 1 PHONE 2 PHONE 123 STATE CITY ZIP PLAYER FORM MUST BE CARRIED WITH THE TEAM MANAGER AT ALL TIMES Dizzy Dean CONSENT FOR TREATMENT FORM Please Print Or Type HOME ADDRESS ID: 258299
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Clear Form PHONE #1: PHONE #2: PHONE: #123 STATE: CITY: ZIP: ALL TOURNAMENT OR TRAVELING TEAMS ARE REQUIRED TO HAVE THIS FORM FOR EACH PLAYER. FORM MUST BE CARRIED WITH THE TEAM MANAGER AT ALL TIMES. Dizzy Dean CONSENT FOR TREATMENT FORM (Please Print Or Type) HOME ADDRESS: NAME: REQUIRED MEDICATIONS: LIST ANY ALLERGIES: FAMILY PHYSICIAN: BLOOD TYPE: POLICY #: DATE: PARENT / GUARDIAN SIGNATURE: Note: Leagues should duplicate this form as needed. HOSPITALIZATION INSURANCE: In case of illness or accident, I hereby authorize a representative of Dizzy Dean Baseball, Inc. to use his/her own judgement in obtaining immediate medical care if a parent or legal guardian cannot be contacted. EMERGENCY TELEPHONE NUMBERS Phone #2 Phone #1 Relationship: Contacts Name: