WINTER 2020 ATHLETIC PERMISSION TO PLAY FORM SPORT TO BE PLAYED IN THE WINTER 2020 Boys BasketballCheerleadingCo-Op Boys SwimmingGirls BasketballIndoor TrackWrestling Student's First Name* Student's Last Name* Grade* FreshmenSophomoreJuniorSenior Address, City and Zip Code* Age* Date of Birth* (mm/dd/yyyy) Phone* Today's Date* (mm/dd/yyyy) Student Signature* PARENT/GUARDIAN CONSENT * I hereby give my consent for the above student to engage in interscholastic athletics at St. Paul Catholic during the current school year and to accompany the team as a member on its out-of–town trips. I understand that my son/daughter will be expected to adhere firmly to all established athletic policies. I also understand that such activity may involve the potential for injury and the possibility of exposure to the COVID-19 virus, which is inherent in all sports. Even with strict observance of rules, injuries (in some cases severe) are still a possibility. EMERGENCY INFORMATION PRIMARY EMERGENCY CONTACT Parent/Guardian* Home Phone Cell Phone SECONDARY EMERGENCY CONTACT Parent/Guardian* Home Phone Cell Phone THIRD EMERGENCY CONTACT: in the event parents cannot be contacted, please contact: Name* Relationship to Student* Home Phone Cell Phone Health Insurance Provider* Policy# MEDICAL TREATMENT CONSENT* I, , The parent/guardian of the above named student, recognize that as a result of athletic participation, medical treatment on an emergency basis may be necessary and further recognize that school personnel may be unable to contact me for my consent for emergency medical care. I do hereby consent in advance to such emergency care, including hospital care, as may be deemed necessary under the then existing circumstance. I understand this authorization will be enforced when I cannot be contacted and provide for immediate treatment. Please make the following notations on my son/daughter's records: Is your child taking any medication?* YesNo Medication(s) Medication Allergies and Symptoms Other relevant medical information (e.g. contact lens wearer, history of family diabetes, epilepsy, heart murmurs) PARENT/GUARDIAN SIGNATURE* Today's Date (mm/dd/yyyy) You will now be redirected to the athletic page to complete any additional forms.