Medical Information Forms

This form is not collecting results at the moment. Medical Information Forms does not collect results after 2018-08-31.

Medical Information Forms

This packet contains medical information forms. In today’s climate of insurance claims and liability action, the use of these forms is mandatory by your club and/or league.

Parent’s Medical Instructions
This form can give your club coach or administrator instructions on how to proceed if an athlete becomes injured or ill and needs emergency treatment.

Medical History Questionnaire
If you are traveling and one of your athletes needs medical attention, this information can be of great value to an attending physician.

The parent’s Medical Instruction and the Medical History Questionnaire for each athlete should be kept in a sealed envelope with his name on the outside in or with the club’s medical kits. It is recommended that the kit also should have a list of emergency phone numbers for each club member, along with the standard 911, police, ambulance, fire, etc., phone numbers.

Please keep all forms on file for a minimum of 48 months.

Instructions

Please indicate another person to call if an accident occurs and we are unable to reach you:

Instructions

Please read the alternative statements below and sign under the one that you choose. Sign only one!

1. If my child needs medical attention, it is my wish that I am contracted before any medical procedures are taken on my child, unless immediate treatment is necessary to save my child’s life or to prevent permanent injury.

Instructions


2. If my child needs medical treatment while participating, it is my wish that the treatment is started while efforts are being made to contact me. So that treatment is not delayed, I consent to any medical procedures that the physician believes are needed, on the understanding that efforts to contact me will continue to be made. I accept responsibility for all costs related to such treatment.


Instructions

MEDICAL HISTORY QUESTIONNAIRE

Instructions

The questions on this form have been answered completely and truthfully to the best of my knowledge.

or cancel

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