Team Medical Examination Consent Form
Please fill out this form to provide consent for the team medical examination.
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.
Known Medical Conditions or Allergies
*
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Consent Statement
*
I hereby give my consent for the medical examination required for participation in the team activities and agree to the use of the medical information as necessary.
Signature of Athlete or Parent/Guardian
*
Submit
Should be Empty: