2020/21 Spring Emergency/Consent Form
Romeo Community Schools Athletic Department:
Information from this will be given to coaches and the Athletic Trainer to have accessible at all practices and games. It will also be kept on file to insure consent has been given for the student-athlete to receive medical treatment. Please take time to fill out the form. MUST BE COMPLETED BY A PARENT/GUARDIAN.

NOT THE SAME AS A PHYSICAL - that must be turned in separately to the athletics office.
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Student's First Name *
Student's Last Name *
Student's Birthdate *
Grade *
Sport *
Required
Student's Home Number
Parent's (or guardian's) Name *
Parent's Cell # *
Parent's Work #
Parent's Email *
Parent #2's (or guardian's) Name
Parent #2's Cell #
Parent #2 Work #
Parent #2 Email
Student's Cell Phone # (Optional but very helpful for AT Staff)
Address (street, city, zip) *
Another Emergency Contact's Name (should not be parent/guardian - you will be called first, this is incase you can't be reached) *
Another Emergency Contact's Cell (should not be parent/guardian - you will be called first, this is incase you can't be reached) *
Allergies?
Known drug reactions?
Current prescribed medications?
Medical/injury history that would be important in case of an emergency?
If possible, is there a certain hospital you'd like your child transported to?
Any other information you feel is important to have on file?
Athlete's T-Shirt size (used for athletic department awarded shirts) *
Important Reminder: If a student-athlete is taken to the doctors at any point, FOR ANY THING, there MUST be a doctor's note given to the athletic trainer describing why the student was seen and if there are any restrictions or full clearance for activity. This is for liability and safety reasons. If there is not a note the athlete will NOT be allowed to practice or play until one is produced. We will be very strict on this moving forward, due to lack of adherence this past fall/winter seasons. Please type your initials here acknowledging you understand and will adhere to this rule so your athlete does not have to sit out. *
I, the parent or guardian, give permission for this student to participate in sport activities. I understand that this is a sporting activity that could cause severe injury. I agree to hold harmless Romeo Community Schools, all its employees and volunteers associated with this activity. I recognize that as a result of athletic participation, medical treatment on an emergency basis may be necessary, and further recognize that school personnel may be unable to contact me for my consent for emergency medical care. I do hereby consent in advance to such emergency care, including hospital care, as may be deemed necessary under the then-existining circumstances and to assume the expenses of such care. BY TYPING MY NAME IN THE BELOW SPACE I AGREE TO ALL OF THE ABOVE. *
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Additional Information:
For more information on Romeo High School's Athletic Training policies and procedures please visit the "sports medicine" page on www.romeoathletics.com.
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