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Medical Release

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The Avon Basketball Association, Inc. (ABA) is a travel basketball program designed for the enjoyment, development and benefit of team members. ABA teams are formed on a ‘Try-Out’ basis and spaces are limited. To participate in the program, tryouts, and open gym sessions, players must be residents of Avon, OH and players participating on an ABA team are not permitted to be rostered on any other team during season.

If you need further information, please contact us.

Registration Form

Fields marked with an * are required

NOTE: To be carried by any Regular Season or Tournament Team Coach together with team roster or International Tournament affidavit.

MEDICAL RELEASE

Player

Date of Birth

Gender

Male

Female

Parent or Guardian Name

Relationship

Parent or Guardian Name

Relationship

Player's Address

City

State/Country

Zip

Home Phone

Work Phone

Mobile Phone

PARENT OR LEGAL GUARDIAN AUTHORIZATION:

In case of emergency, if family physician cannot be reached, I hereby authorize my child to be treated by Certified Emergency Personnel
(i.e. EMT, First Responder, E.R. Physician)

Family Physician

Phone

Address

City

State/Country

Hospital Preference

Parent Insurance Co

Policy No.

Group ID

League Insurance Co

Policy No.

League/Group ID

If parent(s)/legal guardian cannot be reached in case of emergency, contact:

Name

Phone

Relationship to Player

Name

Phone

Relationship to Player

Medical Diagnosis 1

Medication 1

Dosage 1

Frequency of Dosage 1

Medical Diagnosis 2

Medication 2

Dosage 2

Frequency of Dosage 2

Medical Diagnosis 3

Dosage 3

Medication

Frequency of Dosage 3

Medical Diagnosis 4

Medication 4

Dosage 4

Frequency of Dosage 4

Date of last Tetanus Toxoid Booster

The purpose of the above listed information is to ensure that medical personnel have details of any medical problem which may interfere with or alter treatment.

Authorized Parent/Guardian Signature

Date

WARNING: PROTECTIVE EQUIPMENT CANNOT PREVENT ALL INJURIES A PLAYER MIGHT RECEIVE WHILE PARTICIPATING IN BASKETBALL. Avon Basketball Association (ABA) does not limit participation in its activities on the basis of disability, race, color, creed, national origin, gender, sexual preference or religious preference.

Medical Release Form

Liability Waiver

Parent Code of Conduct

Lindsay's Law