Lipscomb University Athletics Athletic Training/Sports Medicine
LEGAL MEDICAL CONSENT
I/We_________________________________________________________________________ (IF UNDER 21 YEARS OF AGE – Parent/Legal Guardian Name Printed) hereby give consent for _________________________________________________________ (Student’s Name Printed) to represent Lipscomb University Intercollegiate Athletics. I/We realize that athletic activity involves the potential for injury. I/We acknowledge that even the best coaching, use of the most advanced equipment, and strict observance of rules, injuries are still a possibility. On rare occasions these injuries can be severe and result in total disability, paralysis, or even death. I/We further grant permission to Lipscomb University,Baptist Sports Medicine, Baptist Hosptial, its physicians and/or Athletic Trainers to render aid, treatment, medical or surgical care deemed reasonably necessary to the health and well being of the above individual. I/We further release Lipscomb University, Baptist Sports Medicine, and Baptist Hospital, its agents, servants, and employees from any liability for damage to the above student and hereby accept the full responsibility to any and all damages or injuries sustained as a result of participation in the sport(s) or extracurricaular activities while a student athlete at Lipscomb University. I acknowledge receiving a copy of Lipscomb University’s Athletic Injury Medical Treatment Procedures and Insurance Filing Procedures. I understand the University’s responsibility to a student who becomes injured while participation in intercollegiate play or official practice at Lipscomb University. I further understand my responsibility to Lipscomb University for following the medical treatment and insurance procedures as explained. Signature of Student Athlete Signature of Parent/Legal Guardian Date Date