Disabled Athlete Emergency Protocol Consent Form
Athlete Information
Full Name
Date of Birth
Type of Disability
Team/Organization
Emergency Contacts
Contact Name
Relationship
Phone Number
Contact Name
Relationship
Phone Number
Medical Information
Primary Physician Name
Physician Phone Number
Current Medications
Allergies
Emergency Care Protocols & Accessibility Needs
Consent and Authorization
I authorize medical personnel to provide emergency treatment as deemed necessary.
I consent to emergency transport if required.
I permit sharing of this information with relevant event staff and medical personnel.
Signature
Date