A medical release is prepared by the parent and gives permission to treat their child in an emergency.  The parent is responsible for the content of the form.  Parents are urged to provide complete and accurate information concerning their child's medical conditions.  In case of a medical emergency, this form may provide emergency personnel information about your child.  NJYS will not verify the information on the form.

It is required that a Medical Release Form be completed for each player.  The coach should have these forms in their possession whenever he/she has charge of the players.

The information on this form includes:

• Player's name, address, Birth date, gender

• Address

• Parent’s names

• Parent's home and work phone numbers

• Emergency contact - name and phone number

• Allergies

• Other medical conditions

• Player’s physician and phone number

• Medical insurance company, policy holder, policy number and group

• Parental signature on the Approval and Medical Release section

• Signature of Notary, date, and expiration of Notary's commission

A player who is over 18 years of age may sign his/her own form.  However, NJYS still requires that there is a medical release for these players as the form identifies any medical insurance that the player may have.

NJYS requires that the form be signed by a parent or legal guardian and that the signature on the form be notarized.  There is no requirement concerning the date that the form was signed by the parent.  A medical release from last year's program can be used if the data provided by the parent is still valid.

The form must be notarized.  There is no requirement as to date on when the form was notarized.  It is also possible that the notary's commission has expired after the form was notarized. That does not change the validity of the signature on the form.  There are no NJYS requirements concerning the dates of signature or notarization.

The District Commissioner will verify that you have a completed Medical Release Form for each player on the roster when the member passes and rosters are validated.

Please make a copy of the blank form for each of your players. You can download the form from our website.

 

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This page last modified on July 28, 2009
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