MEDICAL RELEASE FORM

I,_____________________________ (Parent/Guardian's Name) hereby give permission for

any and all medical attention to be administered to my child ____________________________ 

(Child's
                           Name) In the event of accident, injury, sickness, etc., under the direction of

the person(s) listed below, until
                           such time as I may be contacted.  I also assume the

responsibility for the payment of any such treatment. This
                           release is effective for

the period of one year from the date given below.

ADDRESS:            ______________________________________________________________________

.                   ______________________________________________________________________

HOME PHONE:
                           ______________________________________________________________________

INSURANCE COMP:     ______________________________________________________________________
 
POLICY NUMBER:      ______________________________________________________________________


In case
                           I cannot be reached, any of the following persons is designated to act on

my behalf.

     * COACH: 
                           JEFF ST.JULIEN

     * COACH:          BRYAN FINLEY
       

	 * A league representative where my child
                           is playing.

     * Any tournament representative where my child is participating in a tournament

PHYSICIAN:
                           ____________________________________________________________

ADDRESS: _____________________________________________________________

PHONE: _______________________________________________________________

KNOWN ALLERGIES:____________________________________________________

SIGNATURE (PARENT/GUARDIAN) ________________________DATE  _____________

Subscribed and sworn before me,

this ______ day of __________________ , 200_

________________________________________________
Notary
                           Public