Request edit access
2024-25 STEM Athletic Participation Form
Sign in to Google to save your progress. Learn more
Athlete's Last Name *
Athlete's First Name *
Athlete's Grade *
Athlete's email address *
Sport *
Required
Primary Parent/Guardian's FIRST and LAST Name *
Primary Parent/Guardian's Phone Number to be reached at in an emergency *
Primary Parent/Guardian's email *
Please list any allergies for athlete, or state "none" *
If EpiPen is required for allergies, please enter "yes." Also, enter location where EpiPen will be kept during practice and competition. If not required, indicate "None" *
If an Inhaler is required, please indicate where the Inhaler will be kept during practice and competition. If not required, indicate none. *
Does the athlete have significant health concerns? Please explain, or indicate "none" *
Please add any other health information you feel would be important for us to know about your athlete, or indicate "none" *
Please list all medications, if none are required please enter "none" *
Consent for Emergency Treatment:If a situation occurs in which my son/daughter needs immediate medical attention and I am unavailable to give consent, this signed statement will serve as an authorization for a school representative to obtain any medical care for my son/daughter that is in his/her best interest, until I can be contacted.  I understand that every effort will be made to contact me prior to initiating care.  I also understand that any expenses incurred for emergency transportation and/or care are my responsibility.   *
Required
Please follow the link to view The Code of Conduct and Concussion Information Acknowledgment *
Required
Primary Parent/Guardian's electronic signature *
Student's electronic signature *
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of School District Of Waukesha - Faculty/Staff. Report Abuse
Google Forms