Little League Medical Release Form

The Little League Medical Release Form is required for all players before participating in any practices, games, or team activities. This form provides essential information about your child's medical history, allergies, current medications, and emergency contacts. It ensures that coaches and league officials can respond quickly and appropriately in the event of an injury or emergency.

How to Submit

Parents/guardians must complete and sign the Medical Release Form before the season begins. Once completed submit the form to the Safety Officer by:

• Emailing a scanned copy (preferably a PDF) with the subject line: [Child's Name] Medical Release form.

• Email address: [email protected].

Click here to download the Medical Release Form.

WHAT TO REPORT:

• All accidents/incident which cause an injury and require First Aid, or any medical attention whether the treatment was on or off CLL site must be reported to the Safety Office within a 24-HOUR timeframe.
  
  
• Any near miss incident must be reported to the Safety Officer within a 24-HOUR timeframe.
  
  • Near Miss Incident: Where a person nearly misses being injured while at one of the Cheltenham Little League Complex's. These near misses can be a safety hazard that needs to be addressed before an actual injury does occur. (THIS HELPS CLL TO IDENTIFY SAFETY AREAS OF CONCERNS).

WHO'S RESPONSIBLE FOR FILING THE REPORT:

• Incidents/Injuries to players:
  
  
  • Managers, Coaches, Parents, and League Officials.
• Incidents/Injuries to volunteer/spectators:
  
  
  • Managers, Coaches, and League Officials.

HOW TO REPORT:

1. Complete the Incident/Injury Report Form. The form can be downloaded by clicking here.

2. All sections of the Incident/Injury Report Form must be complete.

• In an emergency situation, make sure at least the contact section of the report is complete.
  
  
• All incidents should be reported to the Safety Officer as soon as possible but no later than 24-HOURS after the incident.

RESPONSIBILITIES OF SAFETY OFFICER DURING INCIDENT/INJURY:

1. The Safety Officer will investigate all incidents/injuries and take the appropriate action.

2. The Safety Officer will contact the injured party(s) or their parents/guardian within 48-HOURS of receiving the Incident/Injury Report to ensure:

• The current condition of the injured party(s).
  
  
• To verify that all the information on the Incident/Injury Report is accurate.
  
  
• To obtain any supplemental information (as needed).

3. If a player misses seven (07) or more continuous days of participation, a physician or other accredited medical provider must give written permission for a full return to baseball/softball activity.

• This also applies to a player that seeks professional medical treatment, whether the injury took place during a CLL activity or during a non-CLL activity (ex. Hospital, Primary Doctor, and Urgent Care).

4. The Safety Officer will forward all incident/injury information to the Board of Directors.

5. The Safety Officer will continue to make periodic follow-ups as necessary until the incident/injury can be considered closed.

6. All Incident/Injury Reports will be kept on file for two years.


WHERE TO SUBMIT INCIDENT/INJURY FORM:

The Incident/Injury Reporting Form can be emailed to the following Safety Officers:

• Ari Summers
  
  
• Diana Montes
  
  
• [email protected]

CONCUSSION SAFETY:

Concussion is a very serious injury to a player. If a manager, coach, umpire, or parent believes that a player has suffer a concussion, the following steps will be taken to ensure the players safety:

1. The player(s) will be removed from the practice or game immediately.

2. Player(s) must be evaluated by a health care professional with experience dealing with concessions. At no time will a non-health care professional judge the seriousness of a player(s) concussion.

3. The player(s) parents/guardians and Safety Officer will be notified of the possible concussion. The Safety Officer will follow-up with the parent(s)/guardian(s) regarding the possible concussion and the parent(s)/guardian(s) will be giving a concussion fact sheet.  Click here to download the concussion fact sheet.

4. The player(s) will stay out of the practice or game for the rest of the day. They may only return to future activities once they have been evaluated and cleared by a health care professional experienced in concussions.

CONCUSSION SIGNS AND SYMPTOMS:

1. Player(s) that are experiencing at least one of the following signs and symptoms listed after a bump, blow, or jolt to the head or body may have a concussion.

• Headache or "pressure" in the head.
  
  
• Nausea or vomiting.
  
  
• Balance problems or dizziness.
  
  
• Double or blurry vision.
  
  
• Sensitivity to light and noise.
  
  
• Feeling sluggish, hazy, foggy, or groggy.
  
  
• Concentration or memory problems.
  
  
• Confusion.
  
  
• Just not "feeling right" or is "feeling down". SIGNS OBSERVED BY THE COACHING STAFF.
  
  
• Appears dazed or stunned.
  
  
• Is confused about their position or assignment.
  
  
• Forgets an instruction.
  
  
• Is unsure of the game, or opponent.
  
  
• Moves clumsily.
  
  
• Answers questions slowly.
  
  
• Loses consciousness (even briefly).
  
  
• Shows mood, behavior, or personality changes.
  
  
• Can't recall events prior to hit or fall.

PENNSYLVANIA CONCUSSION LAW:

For more information on the Pennsylvania Concussion Law visit: https://www.chop.edu/health-resources/youth-sports-concussion-laws-pa-nj

ANYTIME A PLAYER(S) IS STRUCK IN THE HEAD, A MEDICAL PROFESSIONAL SHOULD EXAMINE THEM FOR A CONCUSSION. IF A PLAYER(S) HAS A CONCUSSION, THE PLAYER(S) WILL TAKE THE REQUIRED REST TIME PRESCRIBED BY THE HEALTH CARE PROFESSIONAL BEFORE RETURNING.

EMERGENCY PROCEDURES:

In the event that there is a medical emergency occurs involving a player, volunteer, or a spectator IMMEDIATELY dial 9-1-1. Medical emergencies are, but not limited to:

1. Loss of consciousness or severe head trauma.
   
   
2. An injury that could reasonably include spinal injury or paralysis.
   
   
3. Signs of heart attack or stroke (including heat stroke).
   
   
4. Compound fractures (a broken bone that is penetrating through the skin).
   
   
5. Profuse bleeding, deep wounds.

For all other injuries that do not constitute emergencies, the team manager or coach will consult with the parent(s) or guardian(s), to determine the preferred course of treatment. The Safety Officer has the right to request a medical clearance for the player to return to play after any medical emergency or injury including a "suspected concussion".

IF THERE IS NO PARENT(S) OR GUARDIAN(S) IMMEDIATELY AVAILABLE TO CONSULT WITH, DIAL 9-1-1 TO BE ON THE SAFE SIDE OF THINGS

EMERGENCY CONTACTS:

In the event that there is a Police, Fire, or Medical Emergency, ALWAYS dial 9-1-1 first. Identify your location as 650 Woodland Ave (Woodland Complex) or 276 Harrison Ave (Harrison Ave and Tookany Parkway) (Gimbel Complex). In the event there is no cellular phone available (THIS IS HIGHLY UNLIKELY), there is a land-line phone located inside the snack stand at the Woodland Complex. Unfortunately, there is not a land-line phone inside the snack stand at the Gimbel Complex.

NOTIFYING PARENT(S) OR GUARDIAN(S):

When a player or child is involved in a medical emergency, that player(s) parent(s) or guardian(s) will be notified immediately of the medical emergency. Each team manager should maintain a list of emergency contacts for every player on his/her team and that list will be readily available during all team games and practices. We strongly recommend that these emergency contacts be added to each manager/coach's cell phone contact list.

CHELTENHAM LITTLE LEAGUE ASAP SAFETY PLAN:

Cheltenham Little League is committed to providing a safe and enjoyable environment for all players, coaches, volunteers, and families. Our league follows Little League International's ASAP (A Safety Awareness Program) guidelines, which focus on injury prevention, emergency preparedness, and creating a safe ballpark for everyone.

The ASAP Safety Plan outlines safety procedures, medical response protocols, volunteer training requirements, and field maintenance standards. It serves as a guide for parents, coaches, and league officials to ensure that safety is always the top priority both on and off the field.

To ensure our program remains up to date with best practices and league needs, the safety plan is reviewed and updated annually before each season begins.

To access Cheltenham Little League's Safety Plan, click here.