<p> PLEASE FILL OUT TOP AND BOTTOM FOR ONE SPORT ONLY</p><p>EMERGENCY DATA</p><p>COACHES’ COPY</p><p>SPORT ______STUDENT’S NAME ______DOB______GRADE_____ PARENTS’S NAME ______ADDRESS______TELEPHONE: HOME ______WORK ______CELL______PERSON TO NOTIFY IF PARENT/GUARDIAN NOT AVAILABLE: ______ADDRESS: ______TELEPHONE: HOME ______WORK______CELL______PHYSICIAN ______PHONE ______DENTIST______PHONE ______HOSPITAL PREFERENCE______IN CASE OF EMERGENCY AND YOU ARE NOT AVAILABLE, DO WE HAVE PERMISSION TO TAKE YOUR CHILD TO A HOSPITAL? ______YES ______NO PRE-EXISTING MEDICAL CONDITION (i.e. Asthma) ______LIST MEDICATION STUDENT IS CURRENTLY TAKING______</p><p>______PARENT/GUARDIAN SIGNATURE DATE</p><p>A copy will be given to your son’s/daughter’s coach and the athletic trainer so that information will be available if they are not on school premises.</p><p>EMERGENCY DATA</p><p>TRAINERS’ COPY</p><p>SPORT ______STUDENT’S NAME ______DOB______GRADE_____ PARENTS’S NAME ______ADDRESS______TELEPHONE: HOME ______WORK ______CELL______PERSON TO NOTIFY IF PARENT/GUARDIAN NOT AVAILABLE: ______ADDRESS: ______TELEPHONE: HOME ______WORK______CELL______PHYSICIAN ______PHONE ______DENTIST______PHONE ______HOSPITAL PREFERENCE______IN CASE OF EMERGENCY AND YOU ARE NOT AVAILABLE, DO WE HAVE PERMISSION TO TAKE YOUR CHILD TO A HOSPITAL? ______YES ______NO PRE-EXISTING MEDICAL CONDITION (i.e. Asthma) ______LIST MEDICATION STUDENT IS CURRENTLY TAKING______</p><p>______PARENT/GUARDIAN SIGNATURE DATE</p>