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Parent Release

Parent Release
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Student Name
required
Student Grade
required
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8th
9th
10th
11th
12th
7th
Parent/Guardian Name
required
Parent/Guardian Email
required

In the event of an emergency school closure, we are asking that you sign this release form giving alternate individuals permission to take your child home.
Alternate
Name
required
Address
required
Phone
required
Relationship to student
required
No results found
Grandparent
Aunt
Uncle
Family Friend
Sibling
Other
In the event of an emergency school closure, I would like my child to be able to walk or drive home on their own
required
Yes
No
Parent/Guardian Signature
required
Draw your signature in the area above, or use the saved signature button if available.
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, X-ray examinations and immunizations for the above named student. In the event of serious illness, the need for major surgery, or significant accidental injury, I understand that an attempt will be made by the attending physician to contact me in the most expeditious way possible. If said physician is not able to communicate with me, the treatment necessary for the best interest of the above named student may be given. In the event an emergency arises during a practice session, an effort will be made to contact the parents or guardians as soon as possible. Permission is also granted to the athletic trainer to provide the needed emergency treatment to the student/athlete prior to his/her admission to the medical facilities.
required
I grant my permission
I do not grant my permission
Parent/Guardian Medical Consent Signature
required
Draw your signature in the area above, or use the saved signature button if available.
Phone Number(s) of Parent(s)
Contact Type
required
Cell
Home
Office
Other
Phone Number
required
Name of family physician
required
Physician's phone number
required

HEALTH HISTORY

Please answer the following questions about the student's health history.
Kidney Injuries
required
Yes
No
Heart condition or disease
required
Yes
No
Diabetes
required
Yes
No
Asthma
required
Yes
No
Psychological Disorder
required
Yes
No
Allergies to any medication
required
Yes
No
List medication allergies
required
Allergies to any foods
required
Yes
No
List food allergies
required
While competing, student wears glasses
required
Yes
No
While competing, student wears contacts
required
Yes
No
I will allow over-the-counter medication to be given to my child.
required
Yes
No
Check all the over-the-counter medications that you permit your child to be given
required
Ibuprofen
Cough Drops
Tums/Antacids
Tylenol
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