Athletic Trainer Consent to Treat

Athletic Trainer Consent to Treat 2020-2021

Dear Parents and Guardians,

UCSF Benioff Children’s Hospital – Oakland (BCH-O) provides athletic training services to your student athlete’s high school.  If a student athlete experiences an injury or medical condition during, or in preparation for, their school-sponsored sports season they are eligible to receive these athletic training services with parent or guardian consent.

The purpose of this letter is to inform you of BCH-O athletic training services provided and to obtain your consent to treat your student athlete in the event they experience an injury or medical condition related to participation in their high school-sponsored sport.

Certified athletic trainers (ATs) are highly qualified, multi-skilled health care professionals who collaborate with physicians to provide preventative services, emergency care, clinical diagnosis, therapeutic intervention and rehabilitation of injuries and medical conditions.

The Athletic Training services at your student athlete’s high school include: 

1. On-field injury management; 

2. Evaluation of injury or medical condition; 

3. Post-injury treatment plan; 

4. Referral for further medical attention as needed.

In the event your child experiences an injury or medical condition requiring activity modification and/or further medical evaluation the athletic trainer will notify you and your child’s coach regarding their status and appropriate treatment plan. ATHLETIC TRAINING PERSONNEL ARE UNABLE TO PROVIDE THESE SERVICES TO YOUR STUDENT ATHLETE WITHOUT THIS SIGNED CONSENT.

This signed consent to treat is a requirement for your student athlete to participate in your student athlete’s high school athletic program. If you have any further questions in relation to this program, please contact the high school’s Athletic Director. 

Release of Liability

I hereby grant permission to the athletic training personnel to assess and manage the injury or medical condition and make appropriate recommendations upon assessment deemed reasonably necessary to the health and well-being of the student athlete named. I understand this assessment is not intended to replace a physician’s diagnosis/care and should not be viewed as a substitute. In the event that the athletic training personnel determine the further medical attention is deemed necessary, the athlete will be referred to a physician immediately. I understand that in the event that no progress has been made within two weeks of the initial evaluation, the athletic training personnel reserves the right to defer treatment at that time, and the appropriate referral will be made. I further release UCSF Benioff Children’s Hospital – Oakland and its employees from any liability for damage and injury to the named athlete and hereby accept the full responsibility for any and all damage or injury sustained as a result of participation in sports and extracurricular activities. I attest that the student athlete information I have provided to the high school’s athletic department is correct to the best of my knowledge. I have reviewed and hereby give consent to BCH-O athletic training personnel for the assessment and management of injury or medical condition to the named student athlete.