IHSA - Emergency Information Form - Athletics and Activities
Coaches and sponsors carry this with them at all events in case the parent/guardian is not able to attend and there is an emergency.
Email address *
Student name *
Grade Level *
Parent/Guardian name *
Emergency Contact Number *
2nd Emergency Contact Number *
Physician Name *
Physician number *
Specific health Conditions (if any. if none please list n/a) Asthma, heart conditions, etc... *
If you and the physician of choice (as indicated above) can not be reached in case of an emergency and if, in the judgement for the school authorities, immediate medical and/or hospital attention is indicated, do you authorize responsible school authorities to send your child (properly accompanied) to an available hospital or physician? *
Required
Insurance Information. As the parent/guardian, I wave any claim for liability against the Athletic Co-op, including employees and representatives, and release them from liability in connection with this activity. *
Required
Insurance Carrier *
Policy Number *
Submit
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This form was created inside of Hamilton High School CCSD # 328. - Terms of Service - Additional Terms