Hidden Valley Hurricane Racing Program	Racer Medical Information Form
	Contact Information
	Racer Name:	Age:		Address:
	Parent Name:			Work Phone:
	Home Number:			Cell Phone:
	Emergency Contacts
	Name:	Relation:				Phone Number:
	Name:	Relation:				Phone Number:
			Medical Problems that Effect Your Child Check All That Apply
			Asthma Migraines Low Bone Density Nose Bleeds Allergies If you Answered Yes to Allergies, please specify
	Please Outline Any Specific Concerns You Have Regarding Your Son or Daughter’s Health:				Is your son or daughter currently on any form of medication that could have an implication on their participation in the Hurricane Racing Program?
	Signature:						Date:
Hidden Valley Hurricane Racing Program
	Contact Information
	Racer Name:	Age:		Address:
	Parent Name:			Work Phone:
	Home Number:			Cell Phone:
	Emergency Contacts
	Name:	Relation:				Phone Number:
	Name:	Relation:				Phone Number:
			Medical Problems that Effect Your Child Check All That Apply
			Asthma Migraines Low Bone Density Nose Bleeds Allergies If you Answered Yes to Allergies, please specify
	Please Outline Any Specific Concerns You Have Regarding Your Son or Daughter’s Health:				Is your son or daughter currently on any form of medication that could have an implication on their participation in the Hurricane Racing Program?
	Signature:						Date: