Medical Card For Athlete - Montgomery County Public Schools
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1
2MEDICAL CARD FOR ATHLETE
MCPS Form 560-30
Interscholastic High School Athletics
December 2014
MONTGOMERY COUNTY PUBLIC SCHOOLS • Rockville, Maryland 20850
INSTRUCTIONS: This card should be kept on file in the medical kit for each sport. It should
accompany the athlete to the doctor or hospital when medical attention is required.
Student Name:
Birth Date:
School Name:
Student ID #:
Home Address:
Parent/Guardian Name:
Home #:
Work #:
Cell #:
Parent/Guardian Name:
Home #:
Work #:
Cell #:
If parent cannot be reached, person to be contacted in case of emergency
Name:
Relationship:
Home #:
Work #:
Cell #:
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