In case of emergency please call, illness or accident to the above named student; please check below whom college personnel should contact. Use 1, 2, 3, etc. to indicate your first choice, 2nd and choice and so on. Name Home Phone Business/Cell Phone Mother: Father: Adult Relative: Friend: Family Physician: Hospital preference if conditions warrant immediate transportation _______________________________ Name of Insurance _______________________________________ Group Number ________________ The school does not assume any financial obligation, but does provide the best service possible in an emergency. By signing this form you are giving us authority to follow the above procedure. Check if the above named student has any of the following conditions: Diabetes Convulsions Hemophilia Heart Condition Allergies Asthma Other Is this student under any type of medication? If so, what condition? ____________________________________________________________________________________ Other information the college or medical personnel should know about? __________________________ Should this information change during the year, please contact the TRIO office, (361) 354-2706. Or should this student develop a serious health problem, please notify the Talent Search counselor. __________________________ _________________________________________ Date Parent or Legal Guardian Signature
In case of emergency please call, illness or accident to the above named student; please check below whom college personnel should contact. Use 1, 2, 3, etc. to indicate your first choice, 2nd and choice and so on. Name Home Phone Business/Cell Phone Mother: Father: Adult Relative: Friend: Family Physician: Hospital preference if conditions warrant immediate transportation _______________________________ Name of Insurance _______________________________________ Group Number ________________ The school does not assume any financial obligation, but does provide the best service possible in an emergency. By signing this form you are giving us authority to follow the above procedure. Check if the above named student has any of the following conditions: Diabetes Convulsions Hemophilia Heart Condition Allergies Asthma Other Is this student under any type of medication? If so, what condition? ____________________________________________________________________________________ Other information the college or medical personnel should know about? __________________________ Should this information change during the year, please contact the TRIO office, (361) 354-2706. Or should this student develop a serious health problem, please notify the Talent Search counselor. __________________________ _________________________________________ Date Parent or Legal Guardian Signature
2017-2018%20Club%20Advisor%20Handbook.docx