Athletic Emergency Information
 
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  Athletic Emergency Information  

 
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Fall Sport
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Winter Sport
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Spring Sport
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
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Check All That Apply
 
 
 
 
 
 
 
 
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By Checking Here I give My Consent for Team Physician/Athletic Trainer or Coach to Apply First Aid until Parent/Guardian/Emergency Contact can be reached.*
 
 
 
 
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By Checking Here I Give My Consent for Team Physician/Athletic Trainer/Coaches to use their judgement in securing medical treatment or mbulance service for my son/daughter if Parent/Guardian/Emergency Contact cannot be reached.*
 
 
 
 
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Policy Name
 
 
 
 
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By Checking Yes, I Confirm That The Information Above is Accurate as of the Date Indicated Below*
 
 
 
 
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  mm/dd/yyyy
 
 
 
Done  
Cancel