This health history is complete and accurate. I know of no reason(s), other than the information indicated on this form, why my child should not participate in prescribed activities except as noted. If this information changes during the competition season I will notify the Team Supervisor in writing. I understand that this information will remain confidential to the Coaches, designated person trained in first aid, or emergency personnel as needed. I hereby give permission to the adult in charge to provide routine health care, administer prescribed medications and seek emergency medical treatment including ordering x-rays or routine tests. I agree to the release of any records necessary for insurance purposes. I give permission to the adult in charge to arrange necessary transportation for my child to hospital in an emergency.
Thank you for submitting!