Medical Release Please enable JavaScript in your browser to complete this form.Consent DeclarationI consent to emergency medical care.I do NOT want emergency medical treatment or care administered to my child.Athlete's Name *FirstLastSchoolGrade7th8thFreshmanSophomoreJuniorSeniorDate of BirthPreferred Parent Contact Name *FirstLastPreferred Contact PhoneAlternate Contact PhonePreferred Doctor's NamePreferred Dentist's NamePreferred HospitalInsurance Company NameInsurance Policy/Group NumberPlease list any treatment preferencesPlease list any health conditions or allergiesParent SignatureClear SignatureSubmit
