Athletics

Sport Emergency Medical Form

Mountainview Christian School
Please provide up-to-date emergency and medical information for your student athlete.
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1

Student & Parent Information

Details about the student and parents/guardians.

  • 1.Student's Name *
  • 2.Year / Grade *
  • 3.Date of Birth *
  • 4.Parent's / Guardian's Names *
  • 5.Address *
  • 6.Home Telp *
  • 7.Fax
  • 8.Email *
  • 9.Father's Business Telp
  • 10.Father's Email *
  • 11.Mother's Business Telp
  • 12.Mother's Email *
2

Emergency & Medical

Who to contact and any medical needs.

  • 13.In case of emergency when parents cannot be reached, contact:
  • 14.Home Telp
  • 15.Work Telp
  • 16.Family Doctor
  • 17.Doctor's Telp
  • 18.Special Instructions (allergies, asthma, epilepsy, medications, etc.)
  • Fields marked * are required.

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