LUMMI NATION SCHOOL 
PARENT REVIEW OF ATHLETIC CO-CURRICULAR POLICY, CONCUSSION AND SUDDEN CARDIAC ARREST INFORMATION & MEDICAL EMERGENCY AUTHORIZATION FORM
Please read and fill out this form completely.  All information is required and will be sent to the Lummi Nation School Athletic Office 

By signing below, you acknowledge that as a parent or guardian for a Lummi Nation School athlete and student, you have reviewed and understand the LNS Athletic Packet and Co-Curricular Policy.  My signature also documents I have read the LNS Concussion and Sudden Cardiac Arrest Information Sheet.  You recognize the inherent risk of injury involved in athletic activities.  As a LNS parent/guardian you agree to support your student in following the rules and expectations set forth in by the Lummi Nation School Athletics.  

This agreement is effective for the 2025-26 school year.  

If you have any questions, please contact LNS Athletics at 360-758-4364.

As the parent or Legal Guardian, I authorize the team physician or, in his/her absence, a qualified physician to examine the above-named student and in the event of injury to administer emergency care and to arrange for any consultation by a specialist, including a surgeon, he/she deems necessary to insure proper care of the injury. Every Effort will be made to contact the parent or guardian to explain the nature of the problem prior to any involved treatment.