We provide Athletic Trainer services for high school games.
Name:
Home Address:
City:
State:
Phone:
Email:
CT AT License Number: Please enter "Pending" if you do not currently have a license
Availability to cover games: AfternoonsEveningsWeekends
Completed W9 (with SSN) (Maximum File Size: 3MB)
Athletic Trainer National Certification (ATC) (Maximum File Size: 3MB)
Athletic Trainer State License (LAT) (Maximum File Size: 3MB)
Professional Liability Insurance (Maximum File Size: 3MB)
Basic Life Support/AED (BLS) (Maximum File Size: 3MB)
Resume (Maximum File Size: 3MB)
Comments:
Signature
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