This completed form is necessary for any participant in a TPACT event. Please complete the form and bring it with you to the combine event. Players will not be allowed to participate without completing this form.

Name of Student: _________________________________________________ Date of Birth: ___________________________

Home Address: ___________________________________________________________________________________________

Phone Number: _____________________________________________ High School: __________________________________

Special Medical problems, allergies to medications:

Name of Parent or Guardian: ________________________________________________________________________________

Home Address: ___________________________________________________________________________________________

Business Address: _________________________________________________________________________________________

Daytime Phone Number: __________________________________Evening Phone Number: ______________________________

Parent/Guardian
I give permission for my child named above to participate in a TPACT athletic assessment combine. I hereby release, indemnify and hold harmless TPACT, TopProspects.com, its trustees, officers, agents and employees from any and all liability, damage, claim of any nature whatsoever arising out of or in any way related to my child’s participation in this or any other TPACT event. In case of an emergency and if we cannot be reached, we the undersigned parent or guardian of the abovenamedchild, do hereby authorize a representative of TPACT to consent to any medical treatment or care deemed advisable.

Student
I have read and fully understand all the provisions of the Consent/Release form.

_____________________________________________________                         ____________________

                        Signature of Parent/Guardian                                                             Date

_____________________________________________________                         ____________________

                            Signature of Student                                                                    Date

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                                      Event                                                                              Date