TSATA Instructor’s Course Temporary Waiver Form

A temporary waiver can be granted to offer Sports Medicine I by the Licensed Athletic Trainer who has registered and paid for the next available Instructor’s course. If the Licensed Athletic Trainer fails to complete the class at the next available date, a letter of noncompliance will be sent to the superintendent of the employee’s school district, and the SM I course may no longer be offered. The temporary waiver is granted to the Licensed Athletic Trainer for his/her school only in their school district. The school’s principal must sign the application below for the temporary waiver to be approved.

Temporary license holders are not eligible for this Waiver

Course Date: Jan. 2009

LAT’s Name ____________________________________________________________  

Texas Athletic Trainer’s License Number____________________________________  

Mailing Address: Street____________________________________________________________

City_____________________________________State__________Zip_______  

LAT’s Email Address________________________________________________________________  

LAT’s Signature_______________________________________________________________  

Administrator’s Name__________________________________________________________________  

Administrator’s Title_____________________________________________________  

School District___________________________________________________________  

Address__________________________________________________________  

City_______________________________State__________Zip_____________

Telephone Number________________________________________________________________

Administrator’s Email Address________________________________________________________________

Administrator’s Signature_______________________________________________________________

TSATA Member: Yes____ No_____

Method of Payment: Check______ Credit Card______

Administrative Information:

Registration Fee: $425.00
Participants attending are responsible for any cost.
To be paid by contact/agency by PO Number Check Number  

Prior to Event: Please send a copy of the TSATA Services Training Information w ith your payment before December 15, 2007 to:

Texas State Athletic Trainers Association
1676 Coshatte Road
Bellville, Texas 77418

Any questions regarding enrolling in the Instructor’s Course you may contact:

Spanky Stephens
Executive Director
Texas State Athletic Trainers’ Association
979-865-3333 (O)
512-656-5336 (C)
trainerex@earthlink.net