WHS Pre-Participation Contact & Medical Information Form
DEMOGRAPHIC AND IMPORTANT MEDICAL INFORMATION FOR ATHLETIC TRAINER
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First Name *
Last Name *
Gender *
Athlete's Home Phone # *
Athlete's Cell Phone #
Athlete's Email *
Date of Birth *
MM
/
DD
/
YYYY
Height
Weight
Class Year (Graduation Year) *
Allergies
Medical Alerts/Pre-existing Conditions  (ANYTHING I should know as your sport healthcare provider - new or old) *
*Required - list condition and add additional info below
Required
List/Describe Medical Condition(s)
Current Medications
Fall Sport *
Winter Sport *
Spring Sport *
Parent/Guardian Name *
Parent/Guardian Email *
Parent/Guardian Cell # *
Notes/Comments
Submit
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