UIL Paperwork 2020-2021
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Highland Park Athletic/Liability Release Form
This section will be used in case of emergency.
Please fill out information about your child in this section and read through the following forms found in the following sections.   You will need to initial stating that you have received and read through each form.  You will have to do this for each child if you have multiple children in athletics for the 2020-2021 school year.
LAST NAME OF STUDENT *
FIRST NAME OF STUDENT *
Male or Female
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STUDENT DATE OF BIRTH
MM
/
DD
/
YYYY
Grade (going into for 20-21 school year) *
PARENT/LEGAL GUARDIAN NAME *
PARENT/LEGAL GUARDIAN PHONE NUMBER *
PARENT/LEGAL GUARDIAN EMAIL ADDRESS
EMERGENCY CONTACT NAME *
EMERGENCY CONTACT NUMBER *
FAMILY DOCTOR
FAMILY DOCTOR PHONE NUMBER
INSURANCE COMPANY
INSURANCE POLICY/GROUP NUMBER
KNOWN MEDICAL ISSUES OF STUDENT
MEDICATIONS
ALLERGIES
CONTACT LENSES
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Authorization of consent to treatment of a minor:
We, the undersigned parents/legal guardians of the student listed above, do hereby authorize Highland Park ISD coaches or school representatives act as agent(s) for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment, and hospital care which is deemed advisable by, and is to be rendered under the general or specific supervision of, any physician and surgeon licensed under the provision of the Medical Practice Act, whether such diagnosis or treatment is rendered at the office of said physician or at a hospital.    It is understood 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 our aforesaid agent(s) to give specific consent to any and all such diagnosis treatment or hospital care which the aforementioned physician in the exercise of his/her best judgement may deem advisable.  (Please type your name below) *
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