Fillable Mckinley Monarchs Athletics Emergency Information Form printable pdf download

Mckinley Monarchs Athletics Emergency Information Form

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McKinley Monarchs Athletics Emergency Information Form

Student Name: _________________________ Grade: _____________

Address: __________________________________________________________________________________

Home Phone: _________________ Birthday: _________

_____Female _____Male

Student resides with ____Mother ____Father ____Both ____Other (please list) ____________________________

Mother: ____________________ Address (if different): _____________________________________________

Home phone (if different): ___________________ Cell phone: ___________________ Email: __________________

Employer: __________________________ _______

Employer Phone: ____________________________

Father: ____________________ Address (if different) ________________________________________________

Home phone (if different): ___________________ Cell phone: ___________________ Email: __________________

Employer: __________________________ _______

Employer Phone: ____________________________

Primary Doctor: __________________________________________ Phone: __________________________

Address: _____________________________________________________________________________________

_____ please check to indicate your approval for the school to request the aid of the local

paramedics in whatever community we may be in, in the event of a serious injury or

illness.

Emergency Contacts

Name: ______________________________ Address: _________________________________________________

Home phone: ____________________ Work phone: ____________________ Cell phone: ____________________

Name: ______________________________ Address: _________________________________________________

Home phone: ____________________ Work phone: ____________________ Cell phone: ____________________

Name: ______________________________ Address: _________________________________________________

Home phone: ____________________ Work phone: ____________________ Cell phone: ____________________

Mckinley Monarchs Athletics Emergency Information Form

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