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 2019-2020 school year. Athletes need only complete one form per school year.
Athlete's Name *

First Name Last Name
Date of Birth *

Month Day Year
Parent/Legal Guardian's Name (1) *

First Name Last Name
Phone Number (1) *

Area Code Phone Number
Work Number (1)

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

First Name Last Name
Phone Number (2)

Area Code Phone Number
Work Number (2)

Area Code Phone Number

Athlete's Primary Address *

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