MEDICAL INSURANCE AND AUTHORIZATION FORM 2026

1. Click ‘Get Form’ to open it in the editor.
2. 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.
3. Next, complete the PARENT/GUARDIAN EMERGENCY & CONTACT INFORMATION. Provide details for both parents/guardians including home addresses, phone numbers, employers, and emails.
4. 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.
5. 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.
6. 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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