| Cobber Athletic Home | Emergency/Insurance Form |
Concordia College Returning Athlete Update
Please print form, fill out completely and return to:
Stephanie Brandt - Athletic Trainer
901 South 8th Street
Moorhead, MN 56562
|Date of Birth:|
|Class:||Social Security Number:|
Current Medical Conditions
|Any series illnesses in the last 12 months:|
Please list injuries below that were sustained in the last 12 months:
|Lower Leg Injuries|
|The above statements are true to the best of my knowledge.
This athlete gives consent for the team physician, consulting physician,
Concordia Student Health Personnel and/or appropriate member of the sports medicine staff of Concordia College to examine records, or be in consultation concerning examination or treatment of the athlete for the express prupose of evaluating the medical and/or physical fitness for participation in, or continued participation in any athletic program at Concordia College. The athlete/parent also gives permission for acceptable diagnostic, therapeutic and emergency operative procedures to be carried out in the treatment of illness and injury sustained while a member of a Concordia College Athletic Teams.