Benedictine University

Athletic Training Department

Policy and Consent Form

 

The following documentation is to be read carefully.  If you are under 18 years of age, your parent or guardian must also sign.

 

If you elect not to sign any portion of these documents, please write “Refuse to Sign”, then date and initial in the space provided for signature.

 

Medical Consent

 

I hereby grant permission to the Benedictine University Athletic Training Staff and Team Physicians/Consultants to render to my son or daughter, or to myself, any treatment or medical care deemed reasonably necessary.  This includes preventive care, first aid, rehabilitation, treatment modalities and emergency treatment.  Also, if deemed necessary, I grant permission for hospitalization.

 

_________________________________                   _____________________________________

PRINT NAME                                                                      SIGNATURE

 

_________________________________                   _____________________________________

DATE                                                                                     PARENT/GUARDIAN SIGNATURE

                                                                                                (if under 18 years of age)

 

 

Shared Responsibility for Sports Safety

 

I realize that participation in athletics entails a risk of injury, and that I share responsibility for minimizing the risk of injury to myself and others.  I must promptly report any injury I have suffered to my athletic trainers.  I must give the athletic trainers and coaches a full honest understanding of my physical condition.  I must advise my athletic trainers of any medications that I am taking.

 

I understand that I must report any problems in the condition or usefulness of equipment that I use.  Finally, I know that it is important or me to listen to coaches’ instructions.  I must try, as best as I can, to abide by instructions and guidelines relating safety, and to avoid injuries and accidents in my athletic activity.

 

I have read the above shared responsibility statement, I understand that there are certain inherent risks, and I am willing to assume responsibility while participating at Benedictine University.

 

_________________________________                   ____________________________________

PRINT NAME                                                                      SIGNATURE

 

_________________________________                   ____________________________________

DATE                                                                                     PARENT/GUARDIAN SIGNATURE

                                                                                                (if under 18 years of age)