THIS FORM IS REQUIRED BEFORE ANY PARTICPATION CAN BEGIN
SMG MEDICAL RELEASE FORM
This gives permission to a licensed Medical Physician to administer treatment to the following minor in the
event of a medical emergency which in the opinion of the attending physician may endanger life, cause
disfigurement, physical impairment or undue discomfort if delayed.
This authority is granted only after a reasonable effort has been made to reach me.
August 2016 to May 2017 Athletic Season
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