BRJGT Medical Release Form
Please fill out this form to provide medical release information for each player participating in Blue Ridge Junior Golf Tour events.
Participant Name
First Name
Last Name
Date of Birth
-
Month
-
Day
Year
Date
Address
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Emergency Contact Name
First Name
Last Name
Emergency Contact Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Emergency Contact Relationship
Do you have any existing medical conditions? If yes, please provide details.
Do you have any allergies? If yes, please provide details.
Are you currently taking any medications? If yes, please provide details.
In the event of an injury or medical emergency, do you authorize the staff to administer first aid and seek medical treatment, if necessary?
Yes
No
Parent or Guardian Signature
Date
-
Month
-
Day
Year
Date
Submit
Should be Empty: