YHS Crew Online Emergency Information and Treatment Release

This is a one-time submission form.
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GET A COPY OF THE RELEASE FORM HERE: Emergency Treatment Release Form
Click on the small image to download it.
Print it out, sign it and scan it.
Take a picture of the front and back of your insurance card too.
You will be required to attach the scanned files below.

ROWER INFORMATION

PARENT/GUARDIAN 1 INFORMATION

PARENT/GUARDIAN 2 INFORMATION

EMERGENCY CONTACTS
(Friend or Relative to contact when neither parent can be reached - two required)


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MEDICAL INFORMATION


YesNo


YesNo


YesNo


YesNo


YesNo


YesNo

DON'T FORGET TO ATTACH YOUR FILE(s) BEFORE CLICKING SEND!

For questions about the online form, please contact the YHS Crew webmaster, Dave Underwood at daveu4019@gmail.com
For questions about the information in this form, please contact the YHS Crew registrar, Catherine Lea at registrar@yorktowncrew.org