By signing, you certify that you are a parent or legal guardian of ____________________________________. Further you hereby grant permission to the adult manager and coaches of this team to obtain medical care for any licensed physician, hospital or medical clinic, for the said player at such time as either parent or legal guardian cannot be contacted in person or by telephone. This authorization shall include all activities, including travel to and from CCYB activities; and you do hereby waive, release, absolve, indemnify, and agree to hold harmless the CCYB organization, the organizations supervisors, participants, and persons transporting the player to and from any CCYB activity, for any claim arising out of an injury to the player.

Parent Signature ________________________________________ Date ______________________