JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
Emergency Contact and Authorization for Treatment Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Your Name (first and last)
*
Your answer
Best contact number including area code.
(555-555-5555)
*
Your answer
Swimmers Name (first, middle initial and last)
*
Your answer
Emergency Contact #1 Name
*
Your answer
Emergency Contact #1 Phone Number including area code
*
Your answer
Emergency Contact #2 Name
*
Your answer
Emergency Contact #2 Phone Number including area code
*
Your answer
Emergency Contact #3 Name
Your answer
Emergency Contact #3 Phone Number including area code
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
