• NACA Sports Health & Liability Release Form

    Please complete the following to attend a NACA Sports Tournament. You can save, edit, and return to complete this form. No editing or changes can be made once form is submitted. Form must be completed by ALL athletes and ALL coaches regardless of housing, and ALL on-campus guests.
  • This Health Form is for:*
  • Birthdate*
     / /
    2 digit month, 2 digit day, 4 digit year
  • Gender:*

  • TOURNAMENT & TEAM INFORMATION

  • Arrival Date:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • ATHLETE/MINOR SECTION

  • PARENT/GUARDIAN INFORMATION:

  • Format: (000) 000-0000.
  • Format: (000) 000-0000.

  • MEDICAL INFORMATION:

  • Is athlete allergic to any medicines? If "Yes" please list below.*
  • Is athlete diabetic?*
  • Is athlete asthmatic?*
  • Does athlete have convulsive disorder (seizures)?*
  • Date of athlete's last tetanus shot:*
     - -
    2 digit month, 2 digit day, 4 digit year
  • Does athlete have any food allergies? If "Yes" please list below*
  • Is athlete taking any prescribed medications? If "Yes" please list below.*

  • HEALTH INSURANCE INFORMATION:

  • CONSENT TO TREAT AGREEMENT

  • Pursuant to the Family Rights and Responsibilities Act and Tenn.Code Ann. §63-1-173(c)(1). The NACA nurse staff need permission to care for your athlete as follows:

    • To render aid and to treat any non-emergency health conditions such as stomachache, headache, vomiting, cuts and abrasions, nose bleeds, etc
    • To render aid and to treat any emergency health conditions such as allergic reactions, serious wounds, or injuries, etc.
    • To dispense over-the-counter medication as may be required to treat the athlete.
    • To follow medical orders received from treating physicians or other health care professionals.
  • As the parent/guardian I hereby (check one):*

  • I understand that, if I give consent, then I have the right to revoke consent at any time upon informing NACA office in writing. 

    I also understand that, if I withhold or revoke consent, then I agree that I will come to campus immediately to care for my athlete myself. I also understand that the nurse staff and NACA leadership, in their discretion, may call 911 to deal with any emergency and that if they do, then I will be responsible for any charges. 

  • Date:*
     - -
    2 digit month, 2 digit day, 4 digit year

  • AGREEMENT/LIABILITY RELEASE:

  • I/We agree to hold the National Association of Christian Athletes (NACA) and its agents harmless of any liability resulting from injuries or loss of property sustained by me and our athlete during any NACA function.

    I/We give consent for me and our athlete to receive medical treatment by a registered nurse or licensed physician when deemed necessary by the NACA Committee.

    I/We understand that NACA does not provide any form of accident or sickness medical benefits, including insurance coverage for me and our athlete while participating in NACA activities or on NACA's premises.

    I/We agree that I/We are responsible for all medical expenses incurred from injuries/illnesses that me and our athlete might sustain.

    I understand that as a Participant, me and our athlete may be photographed or videotaped during NACA event functions, and these photos/videos may be used in promotional material.

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