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MEDICAL INSURANCE AND AUTHORIZATION FORM 2026
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How to use or fill out MEDICAL INSURANCE AND AUTHORIZATION FORM
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- Click ‘Get Form’ to open it in the editor.
- Begin by filling out the STUDENT-ATHLETE INFORMATION section. Enter the athlete's legal name, social security number, email, sport, date of birth, and cell phone number.
- Next, complete the PARENT/GUARDIAN EMERGENCY & CONTACT INFORMATION. Provide details for both parents/guardians including home addresses, phone numbers, employers, and emails.
- In the PRIMARY INSURANCE INFORMATION section, input the policyholder’s name, social security number, date of birth, and relationship to the athlete. Select the type of insurance plan and coverage options available.
- Attach a legible copy of the primary insurance card (front and back) in the designated areas. If your child does not have medical insurance coverage, check the appropriate box.
- Finally, review and sign the AUTHORIZATION AND RELEASE OF INFORMATION STATEMENT. Ensure both student-athlete and parent/guardian signatures are included along with dates.
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| Versions | Form popularity | Fillable & printable |
|---|---|---|
| 2015 | 4.8 Satisfied (68 Votes) |
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