Transportation/Emergency Care Authorization Form
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Boys Soccer (Fall)
Girls Soccer (Fall)
V/JV Volleyball (Fall)
Girls Swimming (Fall)
Cross Country (Fall)
Boys Basketball (Winter)
Girls Basketball (Winter)
Boys Swimming (Winter)
Modified Volleyball (Winter)
Indoor Track (Winter)
Track & Field (Spring)
Level (Varsity, JV, Modified)
Student Name (Last Name, First Name)
Date of Birth
Address (include city, state, and zip code)
Phone Number (include area code)
Parent Email Address
Allergy to any medication: Yes/No; If yes, please list.
This document shall be presented to a physician, dentist, or appropriate hospital representative at such time as emergency medical, dental, surgical or hospitalization may be required. I/We being the parent(s) or guardian(s) of the above named student do hereby allow my child to be transported by Southern Cayuga Central School. I/We allow a qualified medical person to act in my/our behalf in authorizing medical, dental, surgical, care and hospitalization for the above named student in the event I/We cannot be reached.
By checking here I acknowledge and agree to authorization as stated above.
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This form was created inside of Southern Cayuga CSD.