Medical Release:

I hereby authorize the coaching staff and agents of the Badger East Youth Football League (“BEYFL”) and Forward Youth Football League ("FYFL"), to use and disclose any and all of my child’s individual health and medical information or other information that I have herein provided or subsequently provide in writing. This release authority applies to any information which may be governed by the Health Insurance Portability and Accountability Act of 1996 (aka HIPPA), 42 USC 1320d and 45 CFR 160164.

Further, I hereby consent and authorize the coaching staff and agents of the BEYFL and FYFL to seek out and authorize the necessary hospital care and/or medical treatment for the child named herein for any illness or injury that may occur while such child is participating in, or in the care or custody of an agent of the BEYFL and/or FYFL. I understand that medical and other information herein or subsequently provided to the BEYFL and/or FYFL will be used if medical treatment and or hospital care is required and I am not immediately available to obtain said medical care or treatment or give my consent for the performance of said care or treatment. The coaching staff and agents of BYFL and/or FYFL will do their best to seek care from the doctor or the hospital as herein provided by me, however, I hereby authorize them to use their best judgement in obtaining expedient and proper care of my child in the event the designated facilities herein are not practical or available under the circumstances.