STAR ATHLETICS MEDICAL HISTORY FORM

Parents,

For your child’s well being and safety we are asking that you provide us with the following information. All information will be kept confidential and only Star Athletics employees will have access to it. Any information given has NO bearing on your athlete’s placement in our program.

2018-2019 Medical History Form

ASTHMA INHALER OR EPI-PEN:

If your athlete requires and inhaler and or an epi-pen you can provide us with an extra one to be kept at the gym. All inhalers/epi-pens will be kept in the office for your athlete’s use only. Please be sure the item has the original prescription label with usage instructions.