Bryst FA | KIX4KIDS – LevelUp Marketing Solutions

Emergency & Medical Contact Information
EMERGENCY CONTACT
In an emergency, when parents cannot be reached, please contact:
Primary Emergency Contact Name*
First Last
Primary Emergency Contact Relationship to Player*
Primary Emergency Contact Phone Number*
Secondary Emergency Contact Name
First Last
Secondary Emergency Contact Relationship to Player
Secondary Emergency Contact Phone Number
MEDICAL HISTORY
If the answer to any of the following questions (below), is yes, please describe the problem and its implications for proper first aid treatment within the registration.
Does the player have any allergies that we need to be aware of?*
- Yes
- No
Please list all the allergies below*
Does the player have any other medical conditions that we need to be aware of?*
- Yes
- No
Please list all the medical conditions that we need to be aware of in the text box below.*

Participant Information