TBF Emergency Medical Form

In the event my son/daughter becomes ill or is injured while participating in any Junior Bass Federation State event, I hereby give my consent to the Texas TBF Federation and its board members to authorize the administration of any emergency medical or dental treatment deemed necessary by a licensed physician or dentist, and the transfer of the child to a hospital, clinic or office to obtain treatment. It is understood that reasonable attempts will be made to contact the parents or guardian at the number listed below prior to administration if reasonably possible.  The following questions will help us to prepare your child for this tournament.

1. A) Any allergies including food, insect bites, and medications? Please list

B) What signs or symptoms result with the allergy (i.e. Difficulty breathing, hives, rash etc)?

C) What is the usual method of treatment when allergy occurs?

2. Does the youth have any medical conditions currently? If so List.

3. Does the youth currently take medication for the above named condition? If so, please list including name of medication (ie. Twice a day, three times daily).

4. Does the youth have any physical limitations?

Please print:

Parent or Guardian Name ______________________Telephone_______________

□   I give my consent for the above emergency treatment.

□  I DO NOT give my consent for the above emergency treatment

Signature____________________________________Date______________