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  • Participant Medical Emergency Card 2011-2012

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    Brooke Martin Fossey
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    PARTICIPANT MEDICAL EMERGENCY CARD 2011-2012 Lacrosse Season Player Name __________________________________ family doctor Player grade__________________ ___ __________________________ ____________________________________ doctor's phone___ _______________________ city_______________ zip__. Birth date mo_________ yr____________................______________. Person to notify if parents cannot be reached:.

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    PARTICIPANT MEDICAL EMERGENCY CARD 2011-2012 Lacrosse Season Player Name __________________________________ family doctor Player grade__________________ ___ __________________________ ____________________________________ doctor's phone___ _______________________ city_______________ zip__. Birth date mo_________ yr____________................______________. Person to notify if parents cannot be reached:.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
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    1K views1 page

    Participant Medical Emergency Card 2011-2012

    Uploaded by

    Brooke Martin Fossey
    PARTICIPANT MEDICAL EMERGENCY CARD 2011-2012 Lacrosse Season Player Name __________________________________ family doctor Player grade__________________ ___ __________________________ ____________________________________ doctor's phone___ _______________________ city_______________ zip__. Birth date mo_________ yr____________................______________. Person to notify if parents cannot be reached:.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    PARTICIPANT MEDICAL EMERGENCY CARD

    2011-2012 Lacrosse Season


    Player Name ___________________________ Family Doctor
    Player Grade___________________________ ________________________________
    Address_______________________________ Doctors Phone_________________________
    City____________ Zip_________

    Special information regarding medical history


    ______________________________________

    Birth date Mo_______ __Day_____ Yr______


    ______________________________________
    HS Player Cell _________________________
    ______________________________________
    Home Phone___________________________
    HS Player E-mail
    Person to notify if parents cannot be reached:
    ______________________________________
    Name_________________________________
    Fathers Name _________________________
    Daytime Phone_________________________
    Fathers Daytime Phone __________________
    Name_________________________________
    Fathers E-mail _________________________
    Daytime Phone_________________________
    Mothers Name ________________________
    Additional Person to E-mail (optional)
    Mothers Daytime Phone_________________ ______________________________________
    Mothers E-mail________________________ Additional Person to E-mail (optional)
    ______________________________________
    US Lacrosse Number ________________ Expiration Date _______________________
    Fall 2011
    Spring 2012
    Both
    Finish Registering by:
    Paid HPGL
    Read, signed and mailed the Highland Park Girls Lacrosse Player and Parent Code of Conduct
    Have an active US Lacrosse membership (Group ID: 2848472)
    Fill out the Registration and Waiver sheet and mail in

    Registering for:

    Youth:
    Registered for the NTYLL website (https://uslacrossentx.secureserverdot.com) Spring Only
    High School:
    Read, signed and mailed the TGHSLL code of conduct

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