Champions Sign-Up Form
Use this form to sign your student up for any Champions program
Student's Full Name
*
First Name
Last Name
Grade
*
Please Select
5th Grade
6th Grade
7th Grade
8th Grade
9th Grade (Freshman)
10th Grade (Sophomore)
11th Grade (Junior)
12th Grade (Senior)
Student's Birthday
*
-
Month
-
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Student Phone Number
Please enter a valid phone number.
Format: (000) 000-0000.
Student's Gender
*
Please Select
Male
Female
Parent/Guardian Name
*
First Name
Last Name
Parent Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent Email Address
example@example.com
Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Media Release
*
I understand and agree
Permission to Provide Necessary Medical Treatment or Emergency Care
*
Yes
No
Medication Disclaimer
*
I understand and agree
Permission to Participate
*
I understand and agree
Mandated Reporter
*
I understand and agree
Fighting/Altercation Policy
*
I understand and agree
I, the parents/caregiver of the student above, acknowledge that I've read and understand all the above.
Submit
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