SALUTE THE GAME | October 13, 2026 1 Emergency Contact & Medical Authorization Salute The Game | October 13, 2026 | Print, sign, and return to Coach B 1. Athlete and guardian identification The private registration must identify the athlete by first and last name and date of birth, and record at least one parent or legal guardian's name, relationship, telephone number, and email address. The signing parent or guardian must have authority to consent for the athlete. This authorization applies only to the program and participation period identified in the registration. 2. Two emergency contacts Provide two emergency contacts, including each person's name, relationship to the athlete, and reachable telephone number. List the order in which staff should contact them if a parent or guardian cannot be reached. Being listed as an emergency contact does not by itself authorize a person to consent to medical treatment or collect the athlete; any pickup authorization must be recorded separately. 3. Relevant health information Privately provide allergies, medical conditions, current injuries, relevant medications, participation restrictions, and any clinician-provided emergency action plan that program staff need to support the athlete safely. Enter “none” where appropriate rather than leaving a required field blank. Update staff promptly when information changes. Do not put a child's medical information in a public page or public comment. 4. Emergency assistance and treatment If the athlete is injured or becomes seriously ill, I authorize program staff to obtain emergency assistance, contact emergency services, and arrange appropriate emergency transportation. If I cannot be reached, I consent, to the extent permitted by law, to necessary emergency evaluation and treatment by qualified healthcare professionals. Staff should attempt to contact me as soon as reasonably possible; contact attempts should not delay urgent assistance. This is not blanket consent for non-emergency treatment. 5. Care instructions, privacy, and expenses This authorization does not permit unqualified staff to diagnose, prescribe, or administer medication outside an approved care plan, training, and applicable law. Relevant information may be shared with responding healthcare professionals when needed for care and otherwise should be available only to authorized staff who need it. The parent or guardian remains responsible for applicable medical charges under the provider's and insurer's terms; this document does not promise program-paid medical coverage or release anyone from liability. 6. Duration and acknowledgment The record must include the selected program, season or activity period, parent or guardian's printed name, signature, date, and document version. The parent or guardian should keep emergency contacts current and tell staff promptly of changed instructions. Any restriction or revocation must be communicated to staff and acknowledged in writing, subject to any emergency authority independently provided by law. Acknowledgment: I confirm that the private registration information is accurate and authorize the emergency assistance and care described above for the identified athlete and participation period. Athlete name: ____________________________________ Date of birth: ______________ Program / team: _________________________________ Season / period: ____________ Parent / guardian name: __________________________ Relationship: _______________ Parent / guardian signature: _______________________ Date: _____________________