HEALTH INFORMATION: List any significant or on-going health conditions relevant to school or athletics (severe allergies / epi pen, asthma ,A.D.D., birth defect, diabetes, epilepsy, heart disease, vision or hearing problem, medications, etc.) I hereby give my consent for medical treatment deemed necessary by physicians for any illness or injury resulting from his/her athletic participation. I understand this authorization will only be enforced when I cannot personally be contacted and provided for immediate treatment. PLEASE LIST any relevant health conditions IN THIS SPACE. Write N/A if there are no health relevant conditions.
*