athlete medical authorization

I grant permission to the medical staff in the emergency area of any hospital or clinic to perform medical/surgical treatment and to administer such anesthetics and/or drugs as may be deemed necessary in the diagnosis and treatment of my child.

This document also grants guardianship over my child during Organized Team Activities with Team ATX such as traveling inside or outside of the US for competitions on artificial climbing walls and or outdoor climbing trips on natural rock.

Participant Name
Participant Name
Guardian's Name
Guardian's Name
Address
Address
Home Phone
Home Phone
Other Phone
Other Phone
Doctor's Name
Doctor's Name
Doctor's Phone
Doctor's Phone
Emergency Contact
Emergency Contact
Emergency Contact Phone
Emergency Contact Phone
Today's Date
Today's Date