Sports Medicine Essentials, 3e - 24

24

CHAPTER 2

|

Legal Considerations and Administration

EMERGENCY INSURANCE
INFORMATION & CONSENT
(Please Print Legibly)

Emergency Contact Information
Athlete's Name: _______________________________________________________________________
Phone: _______________________________________________________________________________
Address: _____________________________________________________________________________
Parent or Guardian's Name: ___________________________________________ (Father/Mother/Guardian)
Circle One

Address: _____________________________________________________________________________
Employer: _____________________________________________________________________________
Home Phone: (______) _______________________ Work Phone: (______) _______________________
E-mail: ____________________________________ Cell Phone: (______) ________________________
Other Parent's/Guardian's Name: ________________________________________ (Father/Mother/Guardian)
Circle One

Address: _____________________________________________________________________________
Employer: _____________________________________________________________________________
Home Phone: (______) _______________________ Work Phone: (______) _______________________
E-mail: ____________________________________ Cell Phone: (______) ________________________
Family Health Accident Insurance
Carrier: _____________________________________________ Group:__________________________
Policy #: ______________________ Group#: ______________________ ID#: _____________________
Family Physician's Name: _______________________________________________________________
Address: _____________________________________________________________________________
Phone: (______) ____________________________ Alt. Phone: (______) _________________________
Serious Medical Conditions: _______________________________________________________________
______________________________________________________________________________________
Allergies (list): _________________________________________________________________________
______________________________________________________________________________________
*******************************************
I/we hereby grant consent to any and all healthcare providers designated by _____________________________
School

to provide my child, _________________________________, any necessary medical care as a result of
any injury/illness.

Athlete's Name

Insurance company, _________________________, (does) (does not) cover football.
Company

Circle One

_________________________________
Signature of Parent/Guardian

___________________
Date

_________________________________
Signature of Parent/Guardian

___________________
Date

2-3 | Sample Emergency Information and Consent Form



Table of Contents for the Digital Edition of Sports Medicine Essentials, 3e

Contents
Sports Medicine Essentials, 3e - Cover1
Sports Medicine Essentials, 3e - Cover2
Sports Medicine Essentials, 3e - A
Sports Medicine Essentials, 3e - B
Sports Medicine Essentials, 3e - i
Sports Medicine Essentials, 3e - ii
Sports Medicine Essentials, 3e - iii
Sports Medicine Essentials, 3e - iv
Sports Medicine Essentials, 3e - Contents
Sports Medicine Essentials, 3e - vi
Sports Medicine Essentials, 3e - vii
Sports Medicine Essentials, 3e - viii
Sports Medicine Essentials, 3e - ix
Sports Medicine Essentials, 3e - x
Sports Medicine Essentials, 3e - xi
Sports Medicine Essentials, 3e - xii
Sports Medicine Essentials, 3e - xiii
Sports Medicine Essentials, 3e - xiv
Sports Medicine Essentials, 3e - xv
Sports Medicine Essentials, 3e - xvi
Sports Medicine Essentials, 3e - xvii
Sports Medicine Essentials, 3e - xviii
Sports Medicine Essentials, 3e - xix
Sports Medicine Essentials, 3e - xx
Sports Medicine Essentials, 3e - 1
Sports Medicine Essentials, 3e - 2
Sports Medicine Essentials, 3e - 3
Sports Medicine Essentials, 3e - 4
Sports Medicine Essentials, 3e - 5
Sports Medicine Essentials, 3e - 6
Sports Medicine Essentials, 3e - 7
Sports Medicine Essentials, 3e - 8
Sports Medicine Essentials, 3e - 9
Sports Medicine Essentials, 3e - 10
Sports Medicine Essentials, 3e - 11
Sports Medicine Essentials, 3e - 12
Sports Medicine Essentials, 3e - 13
Sports Medicine Essentials, 3e - 14
Sports Medicine Essentials, 3e - 15
Sports Medicine Essentials, 3e - 16
Sports Medicine Essentials, 3e - 17
Sports Medicine Essentials, 3e - 18
Sports Medicine Essentials, 3e - 19
Sports Medicine Essentials, 3e - 20
Sports Medicine Essentials, 3e - 21
Sports Medicine Essentials, 3e - 22
Sports Medicine Essentials, 3e - 23
Sports Medicine Essentials, 3e - 24
Sports Medicine Essentials, 3e - 25
Sports Medicine Essentials, 3e - 26
Sports Medicine Essentials, 3e - 27
Sports Medicine Essentials, 3e - 28
Sports Medicine Essentials, 3e - 29
Sports Medicine Essentials, 3e - 30
Sports Medicine Essentials, 3e - 31
Sports Medicine Essentials, 3e - 32
Sports Medicine Essentials, 3e - 33
Sports Medicine Essentials, 3e - 34
Sports Medicine Essentials, 3e - 35
Sports Medicine Essentials, 3e - 36
Sports Medicine Essentials, 3e - 37
Sports Medicine Essentials, 3e - 38
Sports Medicine Essentials, 3e - 39
Sports Medicine Essentials, 3e - 40
Sports Medicine Essentials, 3e - 41
Sports Medicine Essentials, 3e - 42
Sports Medicine Essentials, 3e - 43
Sports Medicine Essentials, 3e - 44
Sports Medicine Essentials, 3e - 45
Sports Medicine Essentials, 3e - 46
Sports Medicine Essentials, 3e - 47
Sports Medicine Essentials, 3e - 48
Sports Medicine Essentials, 3e - 49
Sports Medicine Essentials, 3e - 50
Sports Medicine Essentials, 3e - 51
Sports Medicine Essentials, 3e - 52
Sports Medicine Essentials, 3e - 53
Sports Medicine Essentials, 3e - 54
Sports Medicine Essentials, 3e - 55
Sports Medicine Essentials, 3e - 56
Sports Medicine Essentials, 3e - 57
Sports Medicine Essentials, 3e - 58
Sports Medicine Essentials, 3e - 59
Sports Medicine Essentials, 3e - 60
Sports Medicine Essentials, 3e - 61
Sports Medicine Essentials, 3e - Cover4
http://www.nxtbook.com/nxtbooks/ngsp/autoservice5e
http://www.nxtbook.com/nxtbooks/ngsp/bodystructures13e
http://www.nxtbook.com/nxtbooks/ngsp/refrigerationactech8e
http://www.nxtbook.com/nxtbooks/ngsp/medterminology8e
http://www.nxtbook.com/nxtbooks/ngsp/naturalresources6e
http://www.nxtbook.com/nxtbooks/ngsp/heavydutytruck6e
http://www.nxtbook.com/nxtbooks/ngsp/sportsmedicine2017
http://www.nxtbook.com/nxtbooks/ngsp/agriculturalmechanics
http://www.nxtbook.com/nxtbooks/ngsp/introductoryhorticulture
http://www.nxtbook.com/nxtbooks/ngsp/basicrobotics
http://www.nxtbook.com/nxtbooks/ngsp/weldingprinciplesandapplications
http://www.nxtbook.com/nxtbooks/ngsp/delmars_electricity
http://www.nxtbook.com/nxtbooks/ngsp/modernlivestock_poultryproduction2016
http://www.nxtbook.com/nxtbooks/ngsp/introtoveterinaryscience_2016thirdedition
http://www.nxtbook.com/nxtbooks/ngsp/wildlifeandnaturalresourcemanagement_2016fourthedition
http://www.nxtbook.com/nxtbooks/ngsp/smallanimalcare_management_2016fourthedition
http://www.nxtbook.com/nxtbooks/ngsp/msoffice365_2016intro_illustrated
http://www.nxtbook.com/nxtbooks/ngsp/msoffice365_2016intermediate_illustrated
http://www.nxtbook.com/nxtbooks/ngsp/msoffice365_2016intermediate
http://www.nxtbook.com/nxtbooks/ngsp/msoffice365_2016intro
http://www.nxtbook.com/nxtbooks/ngsp/century21_10e
http://www.nxtbook.com/nxtbooks/ngsp/agriscience6
http://www.nxtbook.com/nxtbooks/ngsp/microsoftoffice2013_first
http://www.nxtbook.com/nxtbooks/ngsp/automotivetech6
http://www.nxtbook.com/nxtbooks/ngsp/dreamweaver_revealed
http://www.nxtbook.com/nxtbooks/ngsp/microsoftoffice2013_intro
http://www.nxtbookMEDIA.com