New York Medical Release Form For Minor ChildNew York Medical Release Form For Minor Child
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I hereby give permission for any and all medical attention necessary to be
administered to my child in the event of an accident, injury, sickness, etc., under
the direction of the people listed below until such time as I may be contacted.
My child’s name is:
(Print Name)__________________________________________________________

This release is effective for the time during which my child is participating in the
Central Western New York Youth Basketball Clubs Inc, practices and any
tournaments they will be competing in for the 2013 season, including traveling to
and from such tournaments. I also hereby assume responsibility for payment of any
such treatment. Furthermore, my child being a member of the Amateur Athletic
Union will be entitled to any or all secondary coverage’s which come into
consideration in this matter.
I also understand that the insurance being provided my child as a member of the
Amateur Athletic Union becomes a primary i