Tiger Up Medical Release Form
Complete this form for Ridgeland Tigers Youth Athletics to provide medical, emergency, and consent information for your child.
Participant Full Name
*
Date of Birth / Age
*
Parent / Guardian Name
*
Primary Phone
*
Please enter a valid phone number.
Format: (000) 000-0000.
Address
*
Email
*
example@example.com
Emergency Contact Name
*
Emergency Contact Phone / Relationship
*
Insurance Provider / Policy Number
Primary Physician / Phone
Known Allergies
Current Medications
Medical Conditions / Restrictions
Does participant carry an inhaler or EpiPen? Yes / No
Additional emergency instructions
My child has a current valid sports physical.
My child has a current valid sports physical.
Cheerleading - No Physical Required
My child will arrive with proper athletic attire, cleats, and water.
My child will arrive with proper athletic attire, cleats, and water.
I understand camp rules, expectations, and safety instructions must be followed.
I understand camp rules, expectations, and safety instructions must be followed.
I understand participation may be denied or stopped if safety concerns arise.
I understand participation may be denied or stopped if safety concerns arise.
I have read this form fully and sign it voluntarily.
I have read this form fully and sign it voluntarily.
Photo / Media Release
YES I allow my child to appear in photos/video used for Ridgeland Tigers Youth Athletics promotions.
NO I do not allow my child to appear in photos/video used for promotions.
Parent / Guardian Signature
*
Date (Parent / Guardian Signature)
*
-
Month
-
Day
Year
Date
Printed Name (Parent / Guardian)
*
Relationship to Participant
*
Submit
Submit
Should be Empty: