Medical Permission Form

Please fill out this form to give us permission to seek attention for your student(s) in case of medical emergency during an athletic competition.

Date*

Student First Name*

Student Last Name*

Grade*FreshmanSophomoreJuniorSenior

Parent/Guardian First Name*

Parent/Guardian Last Name*

Address*

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Address 1:

City:

Country:

State/Province:

Postal Code:

Parent/Guardian Cell Phone* - -

Parent/Guardian Email*

Student Cell Phone* - -

Student Email* - -

Emergency Contact Information (if not parent or guardian above)

Current Families