TE Sports - (Pflugerville, TX) - powered by LeagueLineup.com

Subscribe to our Newsletter

MEDICAL Consent & Waiver Form

* Athlete Name:

MEDICAL INFORMATION:

* Doctor / Clinic and Phone#::

* Known Allergies::

* Medications Taken regularly::

* Medications Taken as needed::

My athlete is required to wear::

Ankle Brace

Wrist Brace

Knee Brace

Glasses or Googles

* Previous Injuries::

MEDICAL/EMERGENCY CONTACT INFORMATION

* Emergency Contact:

* Phone:

* Relationship to Player:

Insurance Carrier:

Policy #:

WAIVER INFORMATION:

I hereby release the TE (Texas Extreme) Sports Network Organization from responsibility for any injuries that should occur to my child in all athletic programs on any campus. I understand that I am responsible for all medical expenses and financial expenses due to any damage of facilities or equipment associated with my athletes' participation in this program.

MEDICAL CONSENT/Assumption of Risk & Release of all Claims
----------------------------------------------------------------------
If in the judgement of any representative of the TE (Texas Extreme) Sports Organization, my child should need immediate medical attention as a result of any injury or illness, I do hereby request, consent, and authorize such care and treatment as may be given any Coach, athletic trainer, nurse, hospital, team representative for the welfare of my child. In the event of serious injury or illness, I understand that every attempt will be made by a TE (Texas Extreme) Sports representative, attending Physician, or Nurse to contact me in the most expedient way possible. If direct communication is not possible, the treatment necessary for the welfare of my child is authorized. I understand that this authorization is given in advance of any specific diagnosis, treatment, or hospital care being required but is given to provide authority and power on the part of the aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care deemed advisable.

I/we agree with the above *

* Parent / Guardian Electronic Signature:

* Date:

* indicates required fields