Athletic Waiver Form Fall 2025

TAUNTON HIGH SCHOOL ATHLETIC DEPARTMENT

AUTHORIZATION FOR MEDICAL TREATMENT

EMERGENCY INFORMATION

I give my permission for the evaluation/treatment of ________________

Student First Name*

Answer required for "Student First Name"

Student Last Name*

Answer required for "Student Last Name"

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*

If sport is not available please contact athletic department:

Answer required for "Sport"

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

Answer required for "Click YES to confirm you are the parent/guardian."

YES

Parent/Guardian Signature*

Answer required for "Parent/Guardian Signature"

Date*

Answer required for "Date"

Athletes Address and Information

Street Address*

Answer required for "Street Address"

City*

Answer required for "City"

Zip/Postal*

Answer required for "Zip/Postal"

Date of Birth:*

Answer required for "Date of Birth:"

Age:*

Answer required for "Age:"

Grade *

(2025-2026 School Year) 8-9-10-11-12

Answer required for "Grade "

Parent/Guardian Contact Information

Parent/ Guardian Name:*

Answer required for "Parent/ Guardian Name:"

Telephone #:*

Answer required for "Telephone #:"

Cell #:

Answer required for "Cell #:"

Alternate Emergency Contact Person:*

Answer required for "Alternate Emergency Contact Person:"

Relationship*

Answer required for "Relationship"

Telephone # (s)*

Answer required for "Telephone # (s)"

Please answer the following medical history questions:

Please check yes if the athlete has had a Concussion.*

Answer required for "Please check yes if the athlete has had a Concussion."

Yes

Please provide information including dates relative to any head injury history

Answer required for "Please provide information including dates relative to any head injury history"

Please check if the athlete has any of the following:

Answer required for "Please check if the athlete has any of the following:"

Diabetes

Epilepsy

Heart Condition

Asthma

Other:

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 list ALL medications, including inhalers and directions for use:

Answer required for "Please list ALL medications, including inhalers and directions for use:"

Please list ALL allergies, including medications, food and insects:

Answer required for "Please list ALL allergies, including medications, food and insects:"

Please provide all insurance information below:

Policy Name*

Answer required for "Policy Name"

Policy Number*

Answer required for "Policy Number"

Subscribers Name*

Answer required for "Subscribers Name"

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 for "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. "

Yes

I, ____________________________,*

Father/Mother/Guardian Name

Answer required for "I, ____________________________,"

the undersigned Father/Mother/Guardian of _____________________________*

Students Name

Answer required for "the undersigned Father/Mother/Guardian of _____________________________"

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 for "Click YES to confirm you are the parent/guardian."

YES

Parent/Guardian Signature*

Answer required for "Parent/Guardian Signature"

Date:*

Answer required for "Date:"

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 for "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 "

Choose a file or drag it here.

*************************************************************************

NFHS Learn Concussion Course: https://nfhslearn.com/courses/concussion-for-students

Electronic signature* *

Signatory must be 18 years of age

Answer required for "Electronic signature* "

Yes, I have watched the NFHSLearn Concussion Course

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

Athletic Fee is $150.

This fee covers either a single season or all three seasons.

Please fix the highlighted areas below before submitting.

Athletic Waiver Form Fall 2025