COLONEL SMITH MIDDLE SCHOOL
FORT HUACHUCA ACCOMMODATION SCHOOLS
P.O. Box 12954 (Building 67601)
Fort Huachuca, Arizona 85670
(520) 459-8892 Fax (520) 459-8939
INTERSCHOLASTIC PARTICIPATION
MEDICAL TREATMENT FORM
Student Name_______________________________ Grade_________
BE IT KNOWN that I, the undersigned parent/guardian of the above named
student, do hereby give and grant unto any medical doctor or hospital my
consent and authorization to render such aid, treatment, and/or care to said
student as, in the event said student should be injured or stricken ill while
participating in an interscholastic activity sponsored or sanctioned by the Fort
Huachuca Accommodation Schools.
IT IS HEREBY understood and agreed that the consent and authorization
hereby given and granted is continuing and is intended by me to extend
throughout the current school year.
________________________
Date
_____________________________________ ____________________
Parent/Guardian Signature
Phone No.
______________________________________ ___________________
Emergency Contact Other Than Parent/Guardian
Phone No.
COLONEL SMITH MIDDLE SCHOOL
Fort Huachuca Accommodation Schools
P.O. Box 12964 (Building 67601)
Fort Huachuca, Arizona 85670
(520) 459-8892 (520) 459-8939
INTERSCHOLASTIC PARTICIPATION
PARENT PERMISSION FORM
Student Name:_____________________________ Grade__________
Sport/Club:____________________________________
I give my permission for my son/daughter to participate in organized
interscholastic Club physical activity. I realize that activity involves the
potential for injury which in inherent in all sports and physical activity. I
acknowledge that even with the best coaching, use of the most advanced
protective equipment and strict observance of rules, injuries are still a
possibility.
It is understood that all reasonable caution will be taken by those in charge to
prevent injuries. It is further understood and agreed that I will indemnify
and hold harmless the Fort Huachuca Accommodation Schools, its officers,
employees and agents in all cases of accidents which may occur as a result of
participation in interscholastic Club events.
I consent for my child to attend on and off campus activities and will provide
transportation home from the school after each activity/event scheduled by
the Fort Huachuca Accommodation Schools.
It is understood that the consent and authorization given is intended only for
the stated Club season.
__________________________________________ _______________________
Parent/Guardian Signature
Date