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Berkshire Fall Athletic Registration
Berkshire Fall Athletic Registration


 
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Price: $135.00


Product Code: 2017-18_BER_ATH_F

General Student Information

Student First Name*:


Student Last Name*:


Gender*:
  

Date of Birth*:
mm/dd/yyyy

Grade*:
  

Does The Student Have an Epi-Pen?*:
  

Does The Student Have an Inhaler?*:
  
Sports Information

Fall Sport*:
  
Details regarding fees.

Seasons*:
  

Position(s):

Phone Numbers

Home Phone #:


Student Cell #:


Mom/Guardn Cell:


Dad/Guardn Cell:

Email Addresses

Student Email:


Mom Email:


Dad Email:

Pre-Participation Physical Exam

Physical Exam*:
  
Physical Form (Completed After 4/15/2017)
Concussion Awareness

Parent/Guardian Agreement*:
  

Student Agreement*:
  
Athletic Participation Parental Approval Form

I Carry Accident/Health Insurance*:
  

Insurance Company Name:


Parent/Guardian Agreement*:
  

Student Agreement*:
  
Athletic Fee and Agreement

Pay to Participate Fee*:
  

Parent/Guardian Agreement*:
  

Student Agreement*:
  

Description
 
Berkshire Fall Athletic Registration


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