CMAthletics Health Form

CMAtheltics' Health Form

Please fill out your athlete's medical information carefully. This form must be submitted before your athlete may participate in any CMAthletic events for the 2021-2022 school year. Athletes need only complete one form per school year.
Athlete's Name*

First NameLast Name
Date of Birth*

MonthDayYear
Has any information changed from previous year?

Yes (Continue with form)No (Continue to Signature Page)
Email
example@example.com
Parent/Legal Guardian's Name (1)*

First NameLast Name
Phone Number (1)*

Area CodePhone Number
Work Number (1)

Area CodePhone Number
Parent/Legal Guardian's Name (2)

First NameLast Name
Phone Number (2)

Area CodePhone Number
Work Number (2)

Area CodePhone Number
Athlete's Primary Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip CodeCountry

Physical Release
I agree to hold Christian Ministries Academy and its agents harmless of any liabilities resulting from injuries or loss of property sustained by me/my child during any athletic function. I give consent for my child to receive medical treatment by a registered nurse or licensed physician when deemed necessary by school officials. THe above-mentioned student is physically fit and mentally stable and prepared to participate in CMAthletic events.
Parent/Guardian's Signature:*

Clear
Should be Empty:

CMAtheltics' Health Form