Athlete Information

The Safe Sports Network offers free evaluation, treatment and rehabilitation of athletic injuries for student athletes of Greater Manchester, NH. Services include outreach to nine local high schools, injury drop-in clinic, annual physicals and coach and community education. The staff is comprised of athletic trainers who work under the direction of Jim Vailas, MD who has been the Safe Sports Network Medical Director since its inception. Coordinating the daily operations is Director of Safe Sports Amy Hollingworth, ATC, RN, NHLAT.

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* 1. Please Enter Today's Date

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* 2. Athlete First Name

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* 3. Athlete Last Name

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* 4. Athlete Birthdate

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* 5. Name of Athlete's Current School

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* 6. Name of Athlete's Current Team/Youth League

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* 7. Parent/Legal Guardian First Name

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* 8. Parent/Legal Guardian Last Name

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* 9. Parent/Legal Guardian Email

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