2020 Summer Youth Clinic

PLAYER INFORMATION

PARENT/GUARDIAN #1

PARENT/GUARDIAN #2

MEDICAL/EMERGENCY CONTACT INFORMATION

MEDICAL WAIVER

Student Athlete Medical Waiver and Consent to Treat


I, the undersigned parent, hereby grant the LDL (representative) of Lady Dragon Lacrosse, the authority to obtain medical treatment for my child. The above care provider(s) shall have the authorization to:



  • Obtain medical treatment and procedures for the child as may be appropriate in emergency circumstances, including treatment by physicians, hospital, clinic personnel, and other health care providers.

  • Obtain routine medical treatment from appropriate health care providers if symptoms of illness (e.g., fever, coughing, irregular breathing, unusual rashes, swallowing problems, etc.) occur.


The grant of temporary authority shall begin on the day this registration is submitted and will remain in effect until the final game of the season, including playoffs, or the End of the Year Banquet, whichever is the later.


In case of emergency, the care provider(s) should first try to contact the parent(s) listed at time of registration. If parents cannot be reached, the care provider should refer to the registration information section Emergency Contact and Medical Information for the next listed contacts as well as the physician and insurance information.

 

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