Work Phone:( )___________________

Parental Consent:

(I) (We), the undersigned, parent(s) of________________________, a minor, do hereby consent to said Minor participating in The Youth Empowerment Baseball College
Authorization of Consent to Treatment of Minor:

(I) (We), the undersigned, parent(s) of _______________________, a minor, do hereby authorize Youth Empowerment Baseball College, hereinafter "Agent", for and on behalf of the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of any physician and surgeon licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital, during all times that the Minor is in the presence of said Agent.

It is understood that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required, but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician in the exercise of his best judgment may deem advisable.

This authorization shall remain effective through the ____ day of ________________, 20__ , unless sooner terminated in writing.

Release of Liability:


_______________________ shall indemnify, hold free and harmless, assume liability for, and defend Youth Empowerment Baseball College, its agents, servants, employees, officers, and directors from any and all liability for personal injury or property damage and costs and expenses including but not limited to, attorney's fees, reasonable investigative and discovery costs, court costs, and all other sums for any claim or action founded thereon, arising or alleged to have arisen out of ________________________(child's name) use of the real or personal property belonging to or used by Agent while Minor is in the presence of Agent.

Parent_____________________________________________ Date:______________
Signed

Parent______________________________________________ Date:______________
Signed