I  (full name) _____________________________________, legal guardian of

 (full name) ______________________________________, born on _________________ hereby

give permission to the Athletic Training Staff at Porterville College and all its host institutions to provide medical treatment within the scope of their practice to the above mentioned student athlete. This includes the prevention, evaluation, care and rehabilitation of athletic injuries as well as referrals/ emergency transportation to medical providers when necessary.

Legal Guardian Signature: _________________________________________ Date: __________