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Medical Consent/Release Form Revised Date: 5/15/2018/IRP
Medical Consent/Release Form
Student-Athlete’s Name:
Please read the following consent forms carefully. The student-athlete’s signature or parent’s
signature (for student under age 18) is required.
Medical Consent
I hereby grant permission to Vance-Granville Community College and team physicians and/or their
consulting physicians and other medical personnel under their direction to render to my
son/daughter/myself any treatment and medical or surgical care that they deem reasonably necessary
to the health and well-being of the student-athlete. I also hereby authorize the athletic trainers at
Vance-Granville Community College, who are under the direction and guidance of their team physicians,
to render to my son/daughter/myself any preventative, first aid, rehabilitative, or emergency treatment
that they deem reasonably necessary to the health and well-being of the student-athlete. I also hereby
authorize the coaching staff at Vance-Granville Community College to render first aid and seek
treatment for my son/daughter/myself as deemed necessary. Also, when necessary for executing such
case, I grant permission for emergency transportation and hospitalization at an accredited hospital. This
consent specifically includes consent to release all information that may be required for treatment,
including but not limited to insurance information.
Student-Athlete’s Signature Date
Parent’s Signature Date
Release and Assumption of Risk
Participation in a sport involves inherent risk of bodily harm and requires an acceptance of risk of injury.
Student-athletes must assume that their participation can result in injury to them, even serious injury.
I understand that by willingly participating in athletics at the collegiate level, I am knowingly undertaking
and assuming a non-controllable risk which may result in an injury that may be severe in nature. Such an
injury may result in paralysis or death. I understand these risks and agree to accept full personal
responsibility for all risks, foreseen and unforeseen, in connection with my participation in athletics at
the collegiate level.
I hereby assume all risks associated with participation in athletics at Vance-Granville Community College
(including transportation to and from events) and agree to waive from liability and hold harmless Vance-
Granville Community College, its employees, agents, representatives, coaches, volunteers, and athletic
