Medical Personnel Pass Application High School*Select Your SchoolAcademy for Technology and the ClassicsAlamo Navajo High SchoolAlamogordo High SchoolAlbuquerque AcademyAlbuquerque High SchoolAnimas High SchoolArtesia High SchoolAtrisco Heritage AcademyAztec High SchoolBelen High SchoolBernalillo High SchoolBloomfield High SchoolBosque SchoolCalvary ChristianCanon Christian AcademyCapital High SchoolCapitan High SchoolCarlsbad High SchoolCarrizozo High SchoolCentennial High SchoolChaparral High SchoolCibola High SchoolCimarron High SchoolClayton High SchoolCleveland High SchoolCliff High SchoolCloudcroft High SchoolClovis Christian SchoolClovis High SchoolCobre High SchoolCorona High SchoolCoronado High SchoolCottonwood Classical Prep SchoolCrownpoint High SchoolCuba High SchoolDel Norte High SchoolDeming High SchoolDes Moines High SchoolDexter High SchoolDora High SchoolDulce High SchoolEast Mountain High SchoolEldorado High SchoolElida High SchoolEscalante High SchoolEspañola Valley High SchoolEstancia High SchoolEunice High SchoolEvangel Christian AcademyFarmington High SchoolFloyd High SchoolFoothill High SchoolFort Sumner High SchoolGadsden High SchoolGallup High SchoolGateway Christian High SchoolGoddard High SchoolGrady High SchoolGrants High SchoolHagerman High SchoolHatch Valley High SchoolHighland High SchoolHobbs High SchoolHondo Valley High SchoolHope Christian High SchoolHot Springs High SchoolHouse High SchoolJal High SchoolJemez Valley High SchoolKirtland Central High SchoolLa Cueva High SchoolLaguna Acoma High SchoolLake Arthur High SchoolLas Cruces Catholic High SchoolLas Cruces High SchoolLegacy AcademyLogan High SchoolLordsburg High SchoolLos Alamos High SchoolLos Lunas High SchoolLoving High SchoolLovington High SchoolMagdalena High SchoolManzano High SchoolMaxwell High SchoolMayfield High SchoolMcCurdy High SchoolMcCurdy Charter SchoolMelrose High SchoolMenaul High SchoolMesa Vista High SchoolMescalero Apache SchoolMesilla Valley Christian SchoolMiyamura High SchoolMonte del SolMora High SchoolMoreno Valley High SchoolMoriarty High SchoolMosquero High SchoolMountainair High SchoolNative American Community AcademyNavajo Pine High SchoolNavajo Prep High SchoolNewcomb High SchoolNM School for the Blind/Visually ImpairedNM School for the DeafNMMI High SchoolNorthwest High SchoolOak Grove Classical AcademyOrgan MountainPecos High SchoolPeñasco High SchoolPiedra Vista High SchoolPine Hill High SchoolPojoaque High SchoolPortales High SchoolQuemado High SchoolQuesta High SchoolRamah High SchoolRaton High SchoolRehoboth High SchoolReserve High SchoolRFK Charter SchoolRio Grande High SchoolRio Rancho High SchoolRobertson High SchoolRoswell High SchoolRoy High SchoolRuidoso High SchoolSan Jon High SchoolSandia High SchoolSandia Prep High SchoolSanta Fe High SchoolSanta Fe Indian SchoolSanta Fe PrepSanta Fe WaldorfSanta Rosa High SchoolSanta Teresa High SchoolShiprock High SchoolSilver High SchoolSocorro High SchoolSpringer High SchoolSt. Michael's High SchoolSt. Pius X High SchoolTaos High SchoolTatum High SchoolTexico High SchoolThoreau High SchoolTierra EncantadaTo'Hajiilee High SchoolTohatchi High SchoolTse'Yi'Gai High SchoolTucumcari High SchoolTularosa High SchoolValencia High SchoolValley Christian AcademyValley High SchoolVaughn High SchoolVolcano Vista High SchoolWagon Mound High SchoolWalatowa Charter High SchoolWest Las Vegas High SchoolWest Mesa High SchoolWingate High SchoolZuni High SchoolMedical PersonnelName* First Last Email* Cell Phone*Role** Disclaimer: The NMAA Consent to Treat Policy provides parental consent for licensed Athletic Trainers (ATC), Nurse Practitioners (NP), Physicians (MD/DO), and Physician Assistants (PA) to provide sports medicine services to all NMAA-member student athletes. If your healthcare provider credentials are excluded from this list, consent has not been given to provide sports medicine services to students from another school. Additionally, your school should have a separate parental consent form on file which permits you to provide sports medicine services to their student-athletes. Athletic Trainer (ATC) Team Physician (MD or DO) Advanced Practice Provider (NP or PA) NM License Number* Verification Statement* I verify that the above information is correct and that I am employed/contracted by my school/district for the 2023-2024 school year. I certify that I am authorized by my school/district to provide medical care and have a current, valid license to practice in the state of New Mexico. Medical Personnel SignatureAthletic DirectorAthletic Director Name* First Last Athletic Director Email* Athletic Director Phone*
