Medical Release
Power Showcase Inc.
9721 Saddle Brook Drive
Boca Raton, FL 33496
Phone: 561-271-7247
5th Annual POWER SHOWCASE International High School Home Run Derby
Medical Release Form
Player Name: ________________________________________________________
Address: ____________________________________________________________
City: _______________________State: _______________ Zip: _________________
Contact Numbers: (Hm) ________________ (Wk) _________________(Cell) ________________
Parent/Guardian (Print Name): _________________________
Parent/Guardian (Signature): ____________________________________
Date: ____________________
Emergency Contact numbers: (Hm) _____________ (Wk) ______________(Cell) _______________
Insurance Carrier: ___________________________________
Policy #: __________________________________________
*********************************************************************************
1. I, the parent/guardian of the above-named candidate for a position in a Power Showcase, Inc event, hereby give my approval to participate in any and all Power Showcase, Inc. activities and events, including but not limited to transportation to and from the activities and events.
2. I know that participation in baseball may result in serious injuries and protective equipment does not prevent all injuries to players, and do hereby waive, release, absolve, indemnify, and agree to hold harmless Power Showcase Inc., its employees, officers, directors, sponsors, supervisors, participants, and/or persons transporting my child to and from activities or events, from any claim arising out of any injury to my child whether the result of negligence or for any other cause.
This is to certify that I, parent or legal guardian of child named above, hereby grant permission to Power Showcase, Inc., its employees, officers, directors or other event representative to authorize, and obtain medical care from any licensed physician, hospital or medical clinic should my child become ill or injured while participating in any Power Showcase, Inc activities or events, when neither parent or legal guardian is available in person or by telephone to grant authorization for emergency treatment.
*********************************************************************
Return this Medical Release to Event Coordinator
Power Showcase Inc.
9721 Saddle Brook Drive
Boca Raton, FL 33496
PLAYERS MAY NOT PARTICPATE UNTIL COMPLETED MEDICAL RELEASE IS ON FILE WITH POWER SHOWCASE, INC.