Sports Performance Program-2024
Registration Form
Student Information
Name
*
First Name
Last Name
School Name
*
Grade (2024/2025 School Year)
*
Please Select
6th
7th
8th
Age
*
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Student T-Shirt Size (t-shirts are adult sizes)
*
Please Select
S
M
L
XL
2XL
3XL
Emergency Contact Information (click to expand)
Emergency Contact Information
Parent/Guardian
Parent/Guardian Name
*
First Name
Last Name
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Parent/Guardian Email
*
example@example.com
Student Emergency Medical Information (click to expand)
Student Emergency Medical Information
Do you have any of the following:
Allergies?
*
Yes
No
Allergies, If "Yes" please list
Epilepsy?
*
Yes
No
Diabetes?
*
Yes
No
Prescribed EPI PEN?
*
Yes
No
Seizures?
*
Yes
No
Dizziness/Fainting?
*
Yes
No
High Blood Pressure?
*
Yes
No
Heart Condition?
*
Yes
No
If Yes, please explain
Irregular Heartbeat?
*
Yes
No
Asthma?
*
Yes
No
Use an Inhaler?
*
Yes
No
If Yes, please list name of inhaler
Wear Contacts?
*
Yes
No
Are you currently taking any medications?
*
Yes
No
If yes, please list medications and purpose
Parent/Guardian Signature
*
By electronically signing this form you are
Submit
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