- EMERGENCY FORM *
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- Student Name
- School Grade
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- I certify that is physically capable and able to fulfill requirements needed to be a cheerleader. I understand that this form legally releases all obligations and responsibilities for the medical treatment of my son/daughter in the event of illness or injury during any squad related activity when either parent cannot be reached. If there is any physical or medical reason why he/she should not participate fully, the school requires a doctor's release. Furthermore, the school is not liable for any injury incurred during cheerleading.
- Parent's signature Date
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- MEDICAL TREATMENT PERMISSION FORM
- In the event of an emergency occurring while my son/daughter is on school sponsored practice, performance, or trip, I grant my permission to the school and it's employee to take whatever action necessary. In the event that i cannot be reached, i hereby authorize the school and /or its employees to give consent for my son/daughter.
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- Home Phone Business Phone
- Address
- City State Zip
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- Person to be notified other than parent or guardian in an emergency
- Name Phone
- Family doctor Phone
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- If you do not grant permission or authorization for consent to medical treatment, what procedure should be followed?
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- Insurance company Policy
- Parent Signature Date
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- MEDICAL INFORMATION
- Heart Condition or disease yes no Asthma yes no
- Diabetes yes no Allergic to medication yes no
- Convulsions disorder yes no Allergic to bee stings yes no
- State allergies Last Tetanus shot
- Additional medical information that may be helpful
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- Any medication currently receiving
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- * FORM FROM NCA COACHES MANUAL
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