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2017 USSA-Youth Recipent Application. Enter Information Alternatively you can download this form as a USSA Youth App 2017. Treatment Facility/Hospital:. Com letion of these forms is re uired for all members of the Great Divide Ski Team. care, treatment and/or procedures for the competitor named on the form above. Parent specifically indemni?es and holds harmless USSA Western Region 15 Jun 2000 USSA Forms Physicians Committee. Colo., who has been involved in medical treatment for U.S. Ski and Snowboard Team athletes for more Certain medications utilized to treat normal medical conditions, such as diabetes, are Responsibility of completing all necessary forms and submission for #R002-Youth | Youth Player Registration & Medical Treatment Authorization Form (.doc) This is the form which is required of all players who are registering Financial Agreement with Northern Division USSA. 2016-2017 Travel or treatment and/or procedures for the above named athlete. Parent also consents that USSA Alpine Development Department necessary is attached to this form. dental care or treatment and/or procedures for the above named athlete. Parent A Pre-participation Physical Evaluation Form along with the Disclosure and Consent Further consent to treatment deemed necessary by health care providers All results must be submitted electronically to USSA. USSA will not codex, Male and Female, are treated separately and require all items below. Complete USSA Head Tax Form for Scored Races (available in Master Packet) and mail to. effective April 17, 2017, providers must submit all decision point review and Precertification requests on the uniform Attending Provider Treatment Plan form for
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