Winter Cheerleading Registration

PLEASE COMPLETE THE FORM BELOW IN ITS ENTIRETY.
THIS MUST BE COMPLETED BEFORE A STUDENT CAN BEGIN A WINTER SPORT.

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Student-Athlete Information

Student First Name*

Student Last Name*

Street, City, Zip*

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Address 1:

City:

Country:

State/Province:

Postal Code:

Grade*

Age*

Date of Birth*

Student-Athlete Signature - Consent to Play*

Parent/Guardian and Emergency Contact Information

Parent/Guardian #1 First AND Last Name*

Phone Number* - -

Email Address*

Parent/Guardian #2 First AND Last Name

Email Address #2

Phone Number #2 - -

Emergency Contact First AND Last Name (other than those listed above)*

Relationship to Student Athlete*

Emergency Contact Phone* - -

Health and Medical Information

Student Athlete Health Insurance AND Policy #*

Emergency Medical Treatment*Yes, as the parent/guardian of the above named student athlete, I 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.

Student-Athlete Physical*St. Paul has the most up-to-date physical form on fileI will drop off the physical form to the St. Paul main office BEFORE the season begins. Not to a Coach.I will upload the physical form below

Up-to-date student-athlete physical form (must be within the last 13 months)

Student-Athlete Physical Form Upload

(doc, docx, jpg, pdf, png)

Does your student athlete take medication(s)?*

If yes, please list all medications:

Medication allergies and symptoms:

Other relevant medical information:

Documents to Review and Acknowledge

Please review the following documents and confirm.

Baseline Concussion Consent Form

I have read and understand the Baseline Concussion Document*Yes

Cardiac Arrest Consent Form

I have read and understand the Cardiac Arrest Document*Yes

Mental Health Consent Form

I have read and understand the Mental Health Document*Yes

Heat Awareness Consent Form

I have read and understand the Heat Awareness Document*Yes

St. Paul Athletic Parent/Student Presentation

Parent - I have read and understand the St. Paul Athletic Parent/Student Presentation*Yes

Student - I have read and understand the St. Paul Athletic Parent/Student Presentation*Yes

Parent - Permission to Play*

I hereby give my consent for the above student athlete 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 which is inherent in all sports. Even with strict observance of rules, injuries (in some cases severe) are still a possibility.