SPORT EMERGENCY MEDICAL FORM
SPORT EMERGENCY MEDICAL FORM
1.
Student’s Name: *
2.
Year/Grade: *
3.
Date of Birth: *
4.
Parent’s/Guardian’s Names: *
5.
Address: *
6.
Home Telp: *
7.
Fax:
8.
Email: *
9.
Father’s Business Telp:
10.
Father’s Email: *
11.
Mother’s Business Telp:
12.
Mother’s Email: *
13.
In case of emergency when parents cannot be reached, contact:
14.
Home Telp:
15.
Work Telp:
16.
Family Doctor:
17.
Doctor's Telp:
18.
Special Instructions (allergies, asthma, epilepsy, medications, etc.)
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