SPORT |
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| Winter |
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| Spring |
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| Student I.D. # |
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| Last Name |
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| First Name |
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| M. I. |
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| Date of Birth |
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| Sex |
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| Grade |
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| Full Street Address |
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| City |
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| Zip |
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| Home Phone |
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| Parent’s Name (Guardian) |
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| 1. Parent Consent: I hereby give consent for the above named student to compete in sports. I authorize the student to go with and be supervised by a representative of the school on any trips. In case this student becomes ill or injured, you are authorized to have the student treated and I authorize the medical agency to render treatment. If any changes in above information or physical condition occur during the year, please notify the P.E. Office. |
Parent Initial |
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| 2. Certificate of Insurance: This is to certify that there is in force an insurance policy which provides no less than $5,000 accident, medical & hospital expense benefit and that such protection meets requirements of Section 3221 of the California Education Code. (Insurance Applications available at school) |
Name of Insurance |
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Policy # |
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Parent Initial |
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| 3. Awareness of Risk: I acknowledge that athletic participation does constitute the risk of injuries, and that a film regarding the risk of participation in sports is available for viewing. |
Parent Initial |
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4. History of schools attended:
The year I entered 9th grade was |
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List schools attended since 9th grade. |
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| 5. Private Transportation: From time to time during the coming year, it may be necessary to use private cars to transport students to activities. The parent’s signature below authorizes the athlete to be transported to and from these activities by private vehicle. Drivers may include teachers, parents, and/or qualified students. (Proof of insurance on file with Principal) |
Initial |
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