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Track Team Consent Form
2/18/2014

 

Hixson Middle School Track Program

 

 

Informed Consent Form

 

I hereby give permission for __________________________ to participate on the

Track Team at Hixson Middle School for the 2013-2014 school year.

A fee of $25.00 is expected for this sport.

(Please Print)

 

 

Student’s Full Name   _____________________________________________________

 

Parent or Guardian      _____________________________________________________

 

Address _______________________________                   DOB   __________________

 

Phone No.       ___________________________________________________

 

Cell No.           ___________________________________________________

 

Alternative Number    _____________________________________________

 

Other person to contact in case of an emergency

Name   _____________________________________________      Relation __________

 

Phone  ______________________________________________

 

Cell      ______________________________________________

 

Family Physician ______________________________________    Phone  ____________

 

Medical conditions (e.g., allergies, chronic illness) ______________________________

________________________________________________________________________

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We understand that each athlete must be a positive representative of Hixson Middle School. He/she must uphold our school’s reputation, exhibiting strong spirit and good sportsmanship at all games. Members not adhering to the above conditions will be removed from the team.

 

We understand this informed consent form and agree to its conditions.

 

Child’s Signature        ______________________________            Date    ___________

 

Parent’s/ Guardian’s   _______________________________          Date    ___________           Signature