Medical Treatment Authorization

Version: 1.0 (draft) Effective date: [DATE]

Accepted per event, per athlete. Not carried over between events.

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Event: [EVENT NAME] Dates: [DATES] Venue: [VENUE, CITY, STATE] Athlete: [ATHLETE NAME], DOB [DOB]

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1. Authorization to treat

As the parent or legal guardian of the Athlete, you authorize [LEGAL ENTITY NAME] d/b/a T3TV Sports, its staff, contracted athletic trainers and medical personnel, venue medical staff, and emergency responders to:

• Provide first aid and on-site care
• Assess and treat injury or illness occurring at the Event
• Arrange ambulance transport to a hospital or urgent care facility
• Consent to examination, anesthesia, diagnosis, x-ray, hospitalization, surgery, and medical treatment by a licensed physician, dentist, or hospital, where in the judgment of the treating provider such treatment is necessary and you cannot be reached in time

This authorization applies during the Event, during travel between event venues under our supervision, and at any T3TV-organized activity connected to the Event.

2. Attempt to contact you first

Staff will make reasonable efforts to reach you and then the emergency contact you provided before authorizing non-emergency treatment. In a genuine emergency, treatment will not be delayed.

Parent or guardian: [NAME] — [PHONE] Emergency contact: [NAME] — [PHONE] — [RELATIONSHIP]

3. Medical information you have provided

You confirm the following is accurate and complete:

Allergies: [FIELD] Medical conditions: [FIELD] Current medications: [FIELD] Recent injuries or surgeries: [FIELD] Dietary restrictions: [FIELD]

[NOTE FOR PRODUCT: the registration form currently collects a single free-text "allergies or medical notes" field. If we want the structured fields above, the form needs to change. Discuss before finalizing — more structured medical data means more sensitive data to protect.]

You agree to notify us promptly if any of this changes before the Event.

4. Medication

T3TV staff do not administer, store, or supervise medication, including inhalers, epinephrine auto-injectors, and insulin, unless separately arranged in writing before the Event.

If the Athlete requires medication during the Event, you are responsible for ensuring the Athlete carries it, knows how to use it, and that a responsible adult is present. Contact T3tv.youth@gmail.com before the Event if the Athlete has a condition requiring an emergency action plan.

[NOTE FOR COUNSEL: several states have statutory requirements around self-carry of asthma and anaphylaxis medication by minors at organized activities. Confirm obligations in each event state.]

5. Financial responsibility

You accept full financial responsibility for all medical care, transport, and treatment provided to the Athlete, including any amount not covered by insurance.

T3TV does not provide health insurance for participants and is not responsible for medical costs.

Health insurance carrier: [FIELD] Policy number: [FIELD]

[NOTE FOR COUNSEL AND PRODUCT: decide whether to collect insurance details. It is standard for youth sports, but it is sensitive data we would then have to secure and retain. Currently not collected.]

6. Concussion

If the Athlete shows signs or symptoms of a concussion, they will be removed from play immediately and will not return to play at the Event without written clearance from a licensed healthcare provider.

You agree to this protocol and agree not to pressure staff or officials to return the Athlete to play.

You confirm that the Athlete has not sustained a concussion in the [PERIOD] before the Event, or that if they have, they have been medically cleared to participate.

[NOTE FOR COUNSEL: Ohio, Georgia, and Florida each have youth concussion statutes. Confirm whether separate statutory acknowledgment forms and educational materials must be provided, and whether this section satisfies them.]

7. Fitness to participate

You confirm the Athlete is in good health and physically capable of participating in strenuous athletic activity, and that no physician has advised against participation.

Our events run long days — up to thirteen hours on a single day — with multiple games. You confirm the Athlete is prepared for this level of exertion.

8. Right to remove from play

T3TV staff, athletic trainers, and officials may remove the Athlete from play at any time on health or safety grounds. This decision is final and does not entitle you to a refund.

9. Privacy of medical information

Medical and allergy information is treated as sensitive. It is visible only to staff with a safety or medical role, is never shared with sponsors, and is retained per our Privacy Policy.

10. Acknowledgment

By checking the box and completing registration, you confirm that:

• You are the Athlete's parent or legal guardian
• The medical information you provided is accurate and complete
• You authorize emergency treatment as described
• You accept financial responsibility for medical costs
• You agree to the concussion protocol

Accepted by: [PARENT NAME] On behalf of: [ATHLETE NAME], DOB [DOB] Date and time: [TIMESTAMP] IP address: [IP] Document version: [VERSION]