Athletics Medical Release Form

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.

Date of Release

August 2017 to May 2018 Athletic Season

Typing your name in this box indicates your electronic signature.

Other contact information in case of emergency.


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