Sports Participation Medical Consent for Minor
Minor's Information
Full Name
Date of Birth
Address
Parent/Guardian Information
Full Name
Relationship to Minor
Phone Number
Email Address
Emergency Contact
Full Name
Phone Number
Medical Information
List any allergies, medical conditions, or medications
Primary Physician's Name
Physician's Phone Number
Health Insurance Provider & Policy Number
Consent & Authorization
By signing below, I, as parent/legal guardian, authorize my child to participate in sports activities and consent to necessary medical treatment in the event of an emergency.
Parent/Guardian Signature
Date