Calvary Sports

This form needs to signed by both Jr. and Sr. High athletes.   

 

 

 SPORTS PERMISSION AND MEDICAL RELEASE

 

 

 

(Student-Athletes Name) ________________________________ in grade _____, has my/our permission to travel to and from athletic games, practices, and activities conducted by Calvary Christian School. I/we, the undersigned parent (s) or guardian, do authorize urgent care personnel to conduct any examination, anesthetic, medical, or surgical diagnosis or treatment, and hospital care which is deemed advisable by and which is to be rendered under the general supervision of licensed urgent care personnel, a physician, and/or surgeon.

 

It is understood that authorization is given in advance of any specific diagnosis treatment or hospital care being required but is given to provide authorization to school personnel to give specific consent to any and all such diagnosis, treatment, or hospital care in the event the parent or guardian cannot be reached in case of emergency when such treatment is deemed necessary in the best judgment of licensed urgent care personnel, physicians, or surgeons. This authorization shall remain effective for the duration of the academic school year, during games, practices, and related sports activities, and while traveling to and from such under the direct supervision of school personnel.

 

Parent/Guardian Printed Name                                                   ______________________________

 

Parent/Guardian Signature                                                         ______________________________

 

Parent/Guardian Primary contact number                                ______________________________

 

Parent/Guardian Printed secondary contact number             ______________________________

 

Doctor’s Name_______________________                        Contact Number ______________________

 

Insurance Carrier _____________________                        Contact Number ______________________