Student Athletic Trainers' Workshop

Which Workshop are You Attending?

Basic Lock Haven Muncy Advanced Muncy First Name Middle Name Last Name Age Grade School Have you had anatomy/physiology classes? Yes No Street Address Line 1 Street Address Line 2 City State Zip Code Country Cell Phone Number Dietary Concerns Sweatshirt/T-Shirt Size Emergency Contact Name Emergency Contact Relation Emergency Contact Phone Number

In the event that my son/daughter is injured or becomes ill, I grant my permission on our family’s behalf in case of an emergency that the personnel of the student athletic trainers’ workshop seek medical assistance as may be deemed necessary under existing circumstances. I understand that individuals who participate in the workshop activities are doing so at their own risk. Susquehanna Health is not responsible for any injury that may occur to individuals participating in workshop activities. Participation in any workshop activity is on a voluntary basis

I agree Your Email Address