Logan County Athletics Spring Registration 2025

Athletic Sports Physical
Student's Name *
School *
Student's Address *
Student Signature*

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Parent Signature*

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Parent's Phone Number *
Upload a picture of the Students Physical (3rd Page Only). Must be signed and dated by a doctor. You can take a picture on your phone and upload it. We may already have a copy on file from other sports. If this is the case don't upload anything.

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Date

MonthDayYear
Date
Does the student have any allergies? *
Does the student take any medications? *
Any other information: (diabetic, asthma, etc.)*

Insurance Information

Required Insurance Information (KHSAA Bylaw 12). Prior to participation in practice or contests (including trying for a place on a team) in any sport or sport activity during the limitation of seasons as defined in Bylaw 23, all students are required to have medical insurance with coverage limits of at least $25,000. If this coverage is provided through the school, contact the Principal or Athletic Director regarding any potential claim. Individual schools and districts may impose additional requirements for insurance or coverage during additional periods for activities outside of Bylaw 23.
Insurance Carrier *
Policy Number/ID Number *
Group Number*
Plan *
Insurance Information: (Please upload a copy of the front of your insurance card). Can take a picture with your phone and upload it. *

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Transportation

Designated adult/adults (other than the parent/guardian permitted to transport student via private vehicle.
First Name Last Name First Name Last Name First Name* Last Name* First Name Last Name First Name Last Name First Name Last Name
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Logan County Spring Athletics Registration 2025