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Student-Athlete Release of Information with Injury, Illness & Surgery History Mobile App

This mobile application is for the release of medical information. It has a written release form for a place to type the students name. It then has a signature page followed by a a log that has the medical information on it.

  • Lendlease
  • The Cooperative
  • PG&E
  • Red Bull
  • Mirvac

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Take a peek inside the Student-Athlete Release of Information with Injury, Illness & Surgery History Mobile App

Included Features

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Included Fields

Customize to add, remove, or edit any of the fields below.

  • Ico textbox

    I, (Full Name)

  • Ico statictext

    the undersigned student-athlete, hereby authorize the Sports Medicine Department to disclose any ...

  • Ico statictext

    I hereby fully release and discharge the University and all its successors, assigns, trustees, of...

  • Ico date


  • Ico signature

    Student-Athlete Signature

  • Ico textbox

    Student Athlete's Name

  • Ico date

    Date of Birth

  • Ico textbox


  • Ico multiline

    Injury/Illness (describe, date, time missed, comments)

  • Ico multiline

    Surgeries (describe, date, return date, comments)

  • Ico multiline


  • ...and More!

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