Emergency Medical Information


  • or mark N/A
  • If option #2 was selected - N/A
  • If option #2 was selected - N/A
  • Person to contact if parent/guardian cannot be reached:

  • In an emergency and when the parent/guardian and family physician are not available, approval is granted to admit this student-athlete to the nearest hospital for treatment by qualified hospital staff.

    By signing this Acknowledgement, you agree that your electronic signature is the legally binding equivalent to your handwritten signature, and is the signature of a Parent and/or Legal Guardian. Whenever you execute an electronic signature, it has the same validity and meaning as your handwritten signature. You may not, at any time in the future, repudiate the meaning of your electronic signature or claim that your electronic signature is not legally binding.