SOCASTEE HIGH SCHOOL ATHLETICS EMERGENCY INFORMATION
By completing this Emergency Information form, you are giving permission for the Socastee High School Sports Medicine Staff  to seek/provide emergency medical treatment for your child.  This may include, but is not limited to, treatment from an Athletic Trainer, Physician, Dentist, EMS, or Hospital Emergency Department.

If it is determined that your child needs medical or dental treatment while participating in athletics, you (the parent/guardian) will be financially responsible for any treatment determined to be necessary by a physician, dentist, athletic trainer, emergency medical personnel, or any other medical personnel.  
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ATHLETE'S FIRST NAME *
ATHLETE'S LAST NAME *
Sex *
Required
Date of Birth *
MM
/
DD
/
YYYY
Grade *
Required
Home(Mailing) Address *
City *
State *
Zip *
Home Phone *
Athlete's Cell Phone
Athlete's Email Address
Drug Allergies/Current Medications/Medical Issues *
Father's Name (FIRST LAST) *
Father's Cell Phone *
Father's Email *
Father's Employer *
Father's Work Phone *
Mother's Name (FIRST LAST) *
Mother's Cell Phone *
Mother's Email *
Mother's Employer *
Mother's Work Phone *
Emergency Contact Name *
Emergency Contact Number *
Family Doctor *
Family Doctor Phone *
Is Your Child Covered by Private Health Insurance or Medicaid? *
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