Parents: Please print this form, fill out, sign and bring to Stony Brook Field on June 24 2017
BREWSTER BASEBALL CLUB, INC.
FREE CLINIC RELEASE FORM
Child’s Name: _________________________________________
Age: ______________
By my signature below, I hereby give my approval for the above named candidate to participate in the Brewster Baseball Club, Inc. (Brewster Whitecaps) free Baseball Clinic. In the event of emergency or injury, I authorize the Brewster Whitecaps staff or its’ representatives to obtain medical care for my child. I assume all financial responsibility for any care rendered. I assume all risks incidental to my child’s participation in the Brewster Whitecaps Baseball Clinic, and agree to hold harmless the Brewster Whitecaps, its staff, representatives, volunteers, clinic participants , Board of Directors and sponsors, from any claim arising out of any medical condition or injury, whether due to negligence or any other cause. My child has no medical condition of which the Clinics’ staff should be aware, except the following:
Signature of Parent of Guardian: ___________________________________________
Printed Name: _______________________________________Date: _____________
