Health Form NACA

NACA Sports Health & 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:*

AthleteCoach or Adult
Visit Info
Tournament Attending*
Arrival Date*

MonthDayYear
School Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Attending with what School/Team *
Coach's Name*

First NameLast Name
Birthdate*

MonthDayYear
Food Allergies?*

YesNo
List all known food allergies*
Please give details and amount of severity.

Adult Info

For an adult or coach participating in the NACA tournament aged 19 or older.
Health Form Name

First NameLast Name
Name*

First NameLast Name
Address*

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code
Email*
example@example.com
Phone Number*

Area CodePhone Number
Emergency Contact Person*

First NameLast Name
Emergency Phone Number*

Area CodePhone Number

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/our child during any NACA function. I/We give consent for my/our child to receive medical treatment by a registered nurse or licensed physician when deemed necessary by the Tournament Director. I/We understand that NACA does not provide any form of accident or sickness medical benefits, including insurance coverage for me/my child while I/my child am (is) 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 I/my child might sustain. I understand that as a Participant, I or my child may be photographed or videtaped during NACA event functions, and these photos/videos may be used in promotional material.
By checking this box I have read, understood, and agree to the above statements.*

Affirmative
Parent/Guardian Signature*

Clear
Adult Signature*

Clear

Please enter your COACH'S EMAIL address to let him/her know you completed this form.

The email will be a NOTIFICATION only. No personal information you filled in on this form will be sent.

"Notification Email Address" must be different from "Email Address"
Notification Email*
example@example.com
Should be Empty:

NACA Sports Health & Release Form