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Granger Rangers Lacrosse

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Player Consent Form

Consent For Athletic Participation and Medical Care

Athlete Information

First name*

Last name*

Middle*

Age*

Grade*

Gender*

Male

Female

Date of Birth*

Month

Day

Year

Allergies*

"N/A" if none

Medications*

"N/A" if none

Emergency Contact Information

Multi-line address

Country/Region*

Address*

City*

Zip / Postal code*

Parent/Guardian Name*

Cell Phone #*

Work Phone #

Parent/Guardian Name*

Cell Phone #*

Work Phone #

Other Contact

Relationship to Athlete

Phone #

Granger Rangers Lacrosse

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Email:

thegrangerrangers@gmail.com

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