Athletic Training Consent Form
Please complete this form to provide consent for athletic training services.
Full Name of Athlete
*
First Name
Last Name
Date of Birth
*
-
Month
-
Day
Year
Date
Parent/Guardian Full Name (if athlete is under 18)
*
First Name
Last Name
Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Do you consent to receive athletic training services?
*
Yes
No
Please list any medical conditions or allergies we should be aware of:
*
Signature of Athlete or Parent/Guardian
*
Date of Signature
*
-
Month
-
Day
Year
Date
Submit
Should be Empty: