HC Crittenden Intramural Medical Emergency Release Form Fall 2023
This form must be filled out by a legal guardian.
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Student Name (First and Last) *
Student Grade *
Sport *
I give permission for the  Byram Hills District coach to take my son/daughter to a hospital emergency room for treatment if necessary during the designated practices/workouts. *
Parent Name (First and Last) *
Parent Email Address *
Daily medication *
If answered yes to the above, please explain:
EpiPen? *
Inhaler? *
Known Allergies? *
If answered yes to the above question, please explain:
Phone number where you may be reached in case of an emergency: *
Alternate emergency contact name if you cannot be reached: *
Alternate emergency contact cell phone number if you cannot be reached: *
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