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Wake County High School Athletic Participation Form
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Document Date: 2013-11-22 12:14:49

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City

Student / /

Company

BP / /

Event

Person Communication and Meetings / /

Facility

UNC Matthew Gfeller Sport-Related TBI Research Center / /

IndustryTerm

athletic insurance policy / student transportation / car accident / insurance / insurance coverage / insurance carrier / /

MedicalCondition

information Vomiting / allergies / exercise-induced asthma / headaches / heart infection / headache / seizures / brain injury / GENITALIA (MALES) HERNIA / uncontrolled diabetes / acute infections / unexplained heart attacks / injury / extreme fatigue / heat stroke / sudden infant death syndrome / illness / unexplained seizure / exercise asthma / head injury / asthma / heat injury / Sports injuries / Sprengel’s deformity / hypertension / Disease / fainting / TBI / uncontrolled seizures / diabetes / seizure / pulmonary insufficiency / pain / allergic reactions / organic heart disease / sickle cell disease / eating disorder / severe muscle cramps / high blood pressure / sickle cell trait / cough / serious brain injury / chronic musculoskeletal condition / injuries / chronic medical illnesses / /

MedicalTreatment

Chiropractic / surgical treatment / surgery / /

Organization

North Carolina Neuropsychological Society / North Carolina High School Athletic Association / PA NP / Wake County Public School System administrative unit / North Carolina High School Athletic Association Sports Medicine Advisory Committee / Wake County Public School System office of Growth Management / North Carolina Medical Society / Medicare / North Carolina Athletic Trainers’ Association / Brain Injury Association of North Carolina / Board of Education / NCHSAA Board of Directors / /

Person

Pledge / Initials Parent / /

Position

WCPSS athletic coach / athletic director / custodian / regular physician / *Legal Custodian / official / flagrant contact / football coach / physician / student-athlete / player / licensed physician / legal custodian / Court Counselor / director of the school / teacher / Athlete / Licensed Physician / Nurse / coach / school nurse / Physician Assistant / attending physician / /

ProvinceOrState

North Carolina / Wake County / /

SportsGame

lacrosse / swimming / tennis / basketball / wrestling / gymnastics / football / soccer / golf / softball / athletics / volleyball / baseball / /

Technology

Sports Medicine / cellular telephone / /

URL

http /

SocialTag