24-25 ATHLETIC FORMS
PARENTS/GUARDIAN COMPLETE this form (2 sections) with your student prior to the start of the 24-25 school year. It is required for each student planning to participate in athletics. 

Please keep this form updated as information changes. A copy of the completed form will be sent to the email address below, with an option to edit your response. 
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Email *
Grade during the 24-25 School Year *
Required
Student Last Name *
Student First Name *
Student Gender *
Sports Student will participate in | Has permission to participate in. (UIL FORM BELOW) *
Required
STUDENT Cell Number *
NA if student does not have a cell phone
STUDENT Date of Birth *
Students Home Address (Street, City, State, Zip Code) *
Parent/Guardian Name 1 *
Parent/Guardian 1 Cell Phone *
Parent/Guardian 1 Email Address *
Parent/Guardian Name 2
Parent/Guardian 2 Cell Phone
Parent/Guardian 2 Email Address
EMERGENCY CONTACT (Other than above Parent/Guardian) Name *
If parent/guardian can not be reached who should we call?
EMERGENCY CONTACT  Cell Number: *
EMERGENCY CONTACT Relationship to Student *
Ex: Aunt/Uncle/Family Friend/Grandparent
Does your Student have HEALTH INSURANCE? *
Please enter HEALTH INSURANCE Information.
INCLUDE: 
  1. Primary Cardholders Name & Date of Birth
  2. Insurance Company Name
  3. Group Number/Member Number/ ID Number
*In case of an emergency and emergency contacts can not be reached.**
Family Physician *
Hospital Preference *
ALLERGIC REACTIONS: To medication, insect stings, foods, etc *
NA or none if none apply
MAJOR MEDICAL CONDITIONS: any pertinent medical conditions or diagnosis needed for your health and safety?  *
NA or none if none apply
List any current MEDICATIONS you are taking, include Over the Counter: *
NA or none if none apply.
**PLEASE PROVIDE THE ATHLETIC TRAINER WITH AN EXTRA INHALER/EPI-PEN IF NEEDED DURING PHYSICAL ACTIVITY.
Have you ever tested POSITIVE for Sickle Cell Anemia, Sickle Cell Trait or any other blood disorders *
OTC MEDICATION DISTRIBUTION
All medication's will be administered in a single prepackaged dose per medication direction.
As a parent/guardian of my child, I have read the policies pertaining to school personnel administering medication and this is your permission to administer medication to my child. I understand and agree that my signature on this form constitutes a waiver of liability. I further acknowledge and agree that when the below medication(s) is administered, I waive any claim I might have against CISD and its employees arising out of administration of said medication. In addition, I agree to hold harmless and indemnify CISD in its employees, either jointly or severely, form in agencies any and all claims, damages, causes of action or injuries occurred or resulting from the administration of said medication(s). *
Check the boxes you DO NOT give permission for administration OR Student can take all Medications
Required
Select one of the following  *
Consenting Parent/Guardian Signature *
By typing your name below, I parent/guardian of above-named minor agree to OTC Medication Distribution.
MEDICAL CONSENT TO TREAT
I, the undersigned, the parent/guardian to the above mentioned minor, do hereby authorize the Commerce ISD District Staff as agent(s) for the undersigned to consent to an 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 rendered and is to be rendered under the general or special supervision of a license physician/surgeon, whether such diagnosis or treatment is rendered at the office of said physician/surgeon 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 provided authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment or hospital which has provided treatment to the above-named minor to surrender physical custody of such minor to (my/our) above named agent (s) upon the completion of treatment.
 *
Consenting Parent/Guardian Signature
By typing your name below, I parent/guardian of above-named minor agree to Medical Consent to Treat.
Date: *
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