Name: _____________________________________SSN#: _____________________________
I give my child permission to use transportation provided by Texas State University-San Marcos and to participate in this Texas State University-San Marcos travel-related activity. He/She has my permission to participate in all activities related to this event.
I also give
permission to an authorized Texas State University-San Marcos representative to
furnish such minor medical care as my son/daughter may require. Further
emergency treatment, i.e. treatment in the event of serious illness/injury or
the need for hospitalization and/or major surgery, is granted, conditional upon
understanding that the
Please complete the section below.
Name of Insurance Company:__________________________________ Policy #_____________
Name of Family Physician:____________________________________ Phone #_____________
In case of emergency, contact______________________________________________________
Work#____________ Home#____________ Relation to student __________________________
Work#_____________ Home#____________ Relation to student__________________________
Date Signature (Parent or Guardian)