Emergency Permission Form

Student's Name
Student's Name
Date of last tetanus shot:
Date of last tetanus shot:
In the event I cannot be reached in an emergency, I hereby give permission to the coaches and staff of Improve Your Game LLC to authorize any and all medical care advised by any licensed surgeon, physician, or other medical personal if it is deemed to be in the best interest of my child. I do hereby indemnify and hold harmless the physician, hospital, and other persons who act in reliance upon this authorization.
I certify all the above information is correct and agree to update information if an of the information changes.
Parent/Guardian Name
Parent/Guardian Name
Date
Date