Parental Consent for Athletic Health Screening

Parental Consent for Athletic Health Screening
Please complete this form to provide consent for your child's participation in the athletic health screening.
Parent/Guardian Full Name
First NameLast Name
Parent/Guardian Email Address
example@example.com
Parent/Guardian Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Student Full Name
First NameLast Name
Student Date of Birth
MonthDayYear
Date
Health Screening Appointment Date
MonthDayYear
Date
Does the student have any allergies or medical conditions we should be aware of?
Parent/Guardian Signature
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Should be Empty: