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2025-2026 Athletic Registration Form
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2025-2026 Athletic Registration Form
2025-2026 Athletic Registration Form
This form requires Javascript to be enabled for submission and authorization.
*
Required
Student Information
Student ID:
*
required
Name
*
required
First Name
Middle (optional)
Last Name
Cell Phone:
*
required
Email Address:
*
required
Gender:
*
required
Grade:
*
required
Date of Birth:
*
required
Must contain a date in M/D/YYYY format
Activity
Winter Sports
*
required
Boys Basketball
Girls Basketball
Competition Cheerleading
Sideline Cheerleading
E-Sports
Indoor Track + Field
Must choose one
Parent/Guardian 1 Information
Name
*
required
First Name
Last Name
Email Address:
*
required
Phone Number:
*
required
Address:
*
required
City:
*
required
State:
*
required
Zip Code:
*
required
Parent/Guardian 2 Information
Name
First Name
Last Name
Email Address:
Phone Number:
Address:
City:
State:
Zip Code:
Medical Information
Pre-participation Physical Form Upload
*
required
Attach up to 5 files with a maximum size of 20MB
Select File(s)
No file chosen
Please be sure the Physical occur within the last 12 months
Primary Doctor
Name
*
required
First Name
Last Name
Address:
Phone Number:
Preferred Hospital
Hospital Name:
Phone Number:
Address:
Preferred Dentist
Dentist Name:
Phone Number:
Address:
Medical Conditions:
*
required
Yes
None
If you selected "Yes" Please write down below in detail the Medical Condition.
Allergies:
*
required
Yes
None
If you selected "Yes" Please write down below in detail the Allergies.
Medical Insurance
Company Name:
*
required
Policy Number:
*
required
Dental Insurance
Company Name:
Policy Number:
Emergency Contact Information 1
Name
*
required
First Name
Last Name
Relationship:
*
required
Day Phone:
Night Phone:
Cell Phone:
*
required
Address:
*
required
City:
*
required
State:
*
required
Zip Code:
*
required
Email Address:
*
required
Emergency Contact Information 2
Name
*
required
First Name
Last Name
Relationship:
*
required
Day Phone:
Night Phone:
Cell Phone:
*
required
Address:
City:
State:
Zip Code:
Email Address:
Student Athlete Handbook Acknowledgment and Agreement
*
required
We have read and understand the
25-26StudentAthleteHandbook.pdf
, and we agree to follow all guidelines and expectations outlined in it
Submit
