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2024 Emergency Medical Authorization
Ayersville Athletic Boosters
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* Indicates required question
Student's Name:
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Your answer
League:
*
T-Ball
8U Softball
10U Softball
12U Softball
JH Softball
16U Softball
8U Baseball
10U Baseball
12U Baseball
JH Baseball
ACME (High School) BaseballJH Softball
Address:
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Your answer
Parent or Guardian, please list your relationship to student with phone number:
*
Your answer
Preferred Physician:
*
Your answer
Preferred Dentist:
Your answer
Preferred Medical Specialist:
Your answer
Facts about your child's medical history including allergies, medications being taken or any physical impairments:
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Your answer
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