CENTER GROVE ULTIMATE CLUB, INC.
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    CGUL player medical authorization

    The purpose of the Medical Authorization Form is to enable parents or guardians of players < 18 years to authorize the provision of emergency treatment for their children who are injured or become ill while under the authority of the chaperone appointed by the Center Grove Ultimate Club, Inc. in the event the parents or guardians cannot be reached.

    ​This release is effective for the time during which my child is participating in any Center Grove Ultimate scheduled events including but not limited to practices, conditioning, tournaments, games, scrimmages. This medical authorization is valid for a Club year (Aug. 1 - July 31).

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    HEALTH CARE PROVIDER & INSURANCE 
    This Medical Authorization Form acknowledges that we (I), the undersigned, parent(s) or legal guardian(s), recognize the potentially hazardous nature of the sport of ULTIMATE and that an injury might be sustained. These injuries include but are not limited to PERMANENT DISABILITY, BLINDNESS, PARALYSIS AND DEATH. In the even of such an injury to my child and we (I or my spouse or guardian) cannot be contacted, we give permission to qualified and licensed EMTs, physicians, paramedics, certified athletic trainers, and/or other medical or hospital personnel to render such treatment. We (I) hereby assume responsibility for any bills resulting from such treatment.

    We (I) release Center Grove Ultimate Club, Inc. and USA Ultimate, its employees, its agents, its volunteers and its assigns from any personal injuries caused by or having any relation to this activity.  We (I) understand that this release applies to any present or future injuries or illnesses and that it binds my heirs, executors and administrators.

    This release form is completed and signed by my own free will and with knowledge of its significance. I have read and understand all of its terms. 
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Center Grove Ultimate Club - Founded (2003) - Incorporated (2014)
​PO Box 1406, Greenwood, IN 46142
  • Home
  • Events
    • Calendar
    • Schedule
  • Team Store
  • Ultimate Guides
    • HS Players' Guide
    • HS Parents' Guide
  • Sponsors
  • Alumni
  • Contact The Club