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Consent to Treat/Medical History Form This is to certify that on this date, I, as parent or guardian of (player participant), give my consent to the Penn Jr. Lacrosse Club and its representative to
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Start by writing the name of the individual or organization that will be certifying the document. This could be your own name or the name of the issuing organization.
02
Next, provide the date on which the certification is being made. Make sure to include the month, day, and year.
03
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04
Include any supporting documents or evidence that may be necessary to validate the certification. This could include references, references, or other forms of documentation.
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Sign the document to validate the certification. If applicable, include the name and title of the certifying individual or organization.
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