5．医务人员和运动员声明Declaration of Medical practitioner and Athlete
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┃我保证运动员使用上述违禁物质对于其上述的伤病是正确的治疗。 ┃
┃I certify that the above mentioned treatment iS medically appropriate and that the use of ┃
┃alternative medication not on the prohibited list would be unsatisfactory for thiS condition． ┃
┃ ┃
┃ ┃
┃医务人员签名： 日期： ┃
┃Medical practitioner’s signature Date ┃
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┃我保证在1项中关于我的信息是准确的，并确认我正在要求批准使用《兴奋剂目录》中的禁用物质或方法。 ┃
┃我同意将我个人的医学信息提交国家体育总局反兴奋剂中心治疗用药豁免委员会以及治疗用药豁免委员会 ┃
┃认为合适的其他专家。 ┃
┃I certify that the information under C01mirth l iS accurate and that I am requesting approval to ┃
┃ use a Substance or Method from the WADA Prohibited List．I authorize the release of personal medical ┃
┃ information to China Anti-Doping Agency（CHINADA）as well as to wADA staff，to the WADA TUEC ┃
┃（Therapeutic Use Exemption Committee）and to other Anti Doping Organization（ADO）under the ┃
┃ provisions of the Code．I understand that if I ever wish to revoke the right of these organizations ┃
┃ to obtain my health information on my behalf，I must notify my medical practitioner and CHINADA ┃
┃ in writing of that fact． ┃
┃ ┃
┃ ┃
┃运动员签名： 日期： ┃
┃Athlete’S Signature Date ┃
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6、运动员注册单位或代表单位意见（盖章）
Declaration of the Athlete’S Registration or representation team（confirmed by official stamp）运动员赛外申请治疗用药豁免，由运动员注册单位同意；运动员赛内申请治疗用药豁免，由运动员代表单位同意。协议积记分或双记分运动员，涉及的单位均应同意。
Athlete’S application for out of competition use of prohibited substances or method has to be agreed by the registration team of the Athlete．Athlete’S application for in competition use of prohibited substances or method has to be agreed by the representation team of the Athlete．TUE application for by exchanged Athlete has to be agreed by all teams involved．
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