Player - Parent Participation Form - Tennessee Heat Sports

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Medical Release Details

As the parent/legal guardian of the athlete specified in this form, I request that in my absence the above-named player be admitted to any hospital or medical facility for diagnosis and treatment. I request and authorize physicians, dentist, and staff duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above minor. I have no guarantee as to the results of the examination or treatment.

Allergies*

Please list any known allergies of this athlete, including any allergies to medicines.

Other Medical Issues*

Please list any other medical problems that should be noted.

Family Physician's Name*

First Last

Family Physician's Phone*

Insurance Carrier Name*

Insurance Carrier Policy#*

Emergency Contact*

Please provide the name of someone to be contacted in an emergency if parent/guardian is not available.

First Last

Emergency Contact Home Phone*

Emergency Contact Work Phone*

Emergency Contact Cell Phone*

Signatures and Confirmation

Entering your name and initials in the questions below provides legal confirmation of your agreements to statements specified.

Parent / Athlete Participation Form*

I have read, agree and completed all details for the Parent / Athlete Participation Form [ View Webpage ]

Yes, I Agree and Confirm

Liability Release Form*

I have read, agree and completed all details for the Liability Release Form [ View Webpage ]

Yes, I Agree and Confirm

Concussion Information Form*

I have read, agree and completed all details for the Concussion Information Form [ View PDF ]

Yes, I Agree and Confirm

Sudden Cardiac Arrest Information*

I have read, agree and completed all details for the Sudden Cardiac Arrest Information [ View PDF ]

Yes, I Agree and Confirm

Athlete Name (Printed)*

First Last

Athlete Initials*

Entering your initials here is a binding agreement to this form.

Parent / Guardian #1 Name (Printed)*

First Last

Parent / Guardian #1 Initials*

Entering your initials here is a binding agreement to this form.

Parent / Guardian #2 Name (Printed)

First Last

Parent / Guardian #2 Initials

Entering your initials here is a binding agreement to this form.

Phone

This field is for validation purposes and should be left unchanged.

Tennessee Heat Sports

Home Educated Athletic Teams

Player – Parent Participation Form

Player and Parent Details

Cumulative Grade Point Average

Medical Release Details

Signatures and Confirmation