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Athletic Waiver Form Winter 2020-2021

TAUNTON HIGH SCHOOL ATHLETIC DEPARTMENT

AUTHORIZATION FOR MEDICAL TREATMENT

EMERGENCY INFORMATION

I give my permission for the evaluation/treatment of  ________________

by any duly Licensed physician and/or hospital facility in the event of illness or injury.  I also authorize transportation in an ambulance if necessary.

Sport*
Answer Required
Click YES to confirm you are the parent/guardian.*
Answer Required

Athletes Address and Information

State*
Answer Required

Parent/Guardian Contact Information

Please answer the following medical history and physician's questions:

Please check yes if the athlete has had a Concussion.*
Answer Required
Please check if the athlete has any of the following:
Answer Required
  • Diabetic students must have glucose tablets and a glucometer present at all practices and games.
  • Asthmatic students must have inhaler present at all practices and games.
  • All athletes must report any medical changes to the Athletic Director’s Office and the Athletic Trainer.

Please provide all insurance information below:

If you need to obtain the Additional Voluntary Insurance offered by the Taunton School Department’s Athletic Insurance Policy please check here and an enrollment form will be sent home with your student athlete.
Answer Required

a minor, do hereby consent to his/her participation in voluntary athletic programs and do forever RELEASE, acquit, discharge and covenant to hold harmless the City of Taunton, the Taunton School District, Taunton High School and any employees or agents of said City, District, and High School from any and all actions, causes of action and claims on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which I may now or hereafter as the parent/guardian of said minor, and also all claims or right of action for damages which said minor has or hereafter may acquire, either before or after he/she has reached his/her age of majority resulting from his/her participation in the Taunton Public Schools Physical Education Department’s Athletic Program. 

I have read the above statement and agree to its terms.

Click YES to confirm you are the parent/guardian.*
Answer Required
Copy of physical within 13 months mandatory to try out for any team at THS: Please upload child's physical if electronic copy is available: Convert pictures into PDFs when possible
Answer Required
or drag it here.

Fax a copy of physical if not able to electronically submit at 508-821-1149.

Athletic Fees are waived this year due to Covid-19.

 

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