Consent to Treat and Participation Form

I hereby consent to the above named student-athlete participating in the interscholastic athletic
program at Ridgevue High School. This consent includes travel to and from athletic contests and
practice sessions.

I further consent that the certified athletic trainer or coach may apply first aid treatment for any
injury or injuries sustained during practice or games in interscholastic athletics sanctioned by
Ridgevue High School until the parent/guardians can be contacted

I hereby consent the certified athletic trainer, school administrator, or coach may secure medical
first aid, ambulance services, and if necessary emergency room care, when needed, as a result of
injury during participation in sanctioned practices/games scheduled by Ridgevue High School

My participation in interscholastic athletics for the above school is entirely voluntary on my part,
and with the understanding that I have not violated any of the eligibility rules and regulations of
the state association.