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 Name
Last 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 Name
Last Name
Student Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Health Screening Appointment Date
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Does the student have any allergies or medical conditions we should be aware of?
*
Parent/Guardian Signature
*
Submit Consent
Submit Consent
Should be Empty: