Medical Information and Release for Football
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Email *
Last, First, Middle Name *
Height and Weight *
Date of Birth and Age *
Sex  *
Address *
Name of Parent or Guardian  *
Parent Address *
Primary Email Address *
Home Phone *
Parent Work Phone *
Dad's Phone *
Mom's Phone *
Name, Address, and Phone of Family Doctor *
List and explain any chronic or acute medical problems or allergies *
List all medication being taken at present *
My child has permission to participate in athletics at Community Christian School, hereinafter referred to as the Athletic Program. I fully realize that injury or illness to my child could result from or during participation in the Athletic Program. In case of accident or illness, I give permission for my child to receive medical treatment as deemed appropriate. I will assume responsibility for any medical bills other than those covered  the school's insurance program. 
Parent Signature:
 *
Travel Release and Hold Harmless Agreement:
I understand that by signing below, and in consideration of Community Christian  permitting my child to participate in the Athletic Program, I agree to release and hold harmless Community Christian School, its faculty, staff, and students, from any loss, claim, demand or cause of action that I or my heirs, executors, or assignees, may have, either now or at any time in the future, arising out of or in any way connected with the Athletic Program. 
I understand that I am releasing Community Christian School of liability for all property damage or personal injuries that my child may cause while traveling to and from sporting events. 
Parent Signature:
 *
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