*Student Information Above Must be Entered as it Appears in Skyward*
***Please include the "0" in your Student ID field above***
EMERGENCY INFORMATION CARD
*Required
Medication Permission
I authorize and consent to a Licensed Athletic Trainer to administer non-prescription medication to said student after consultation with the
team designated physician, or representative.
Consent Statement: If, in the judgment of any representative of the school, the above student should need immediate care and treatment as a result of
any injury or sickness, I authorize the Pasadena Independent School District athletic staff as agent(s) for the undersigned to consent to such treatment
as may be given to said student by any physician, athletic trainer, nurse, hospital, or school representative; and do hereby agree to indemnify and save
harmless the school and any school representative from any claim by any person whomsoever on account of such care and treatment of said student.
I authorize any physician or medical facility to release confidential information concerning an athletic injury or illness to the licensed athletic training staff.
Pursuant to the Texas Uniform Electronic Transmissions Act, an electronic signature has the same legal effect as a manual or handwritten signature. An electronic signature will not be denied legal effect or enforceability solely because it is electronic, and any requirement for a signature is satisfied by an electronic signature. By submitting an electronic signature, the individual identified and providing the electronic signature herein verifies acknowledgement of the binding legal effect and enforceability of the electronic signature. By clicking the box beside "I agree", you agree that this is valid as your signature. You hereby swear that you are the parent or legal guardian of the above named student and that the information is accurate to the best of your knowledge.
*Required