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Wisconsin Interscholastic Athletic Association Alt. Year Athletic Permit Card
ALL STUDENTS PARTICIPATING IN INTERSCHOLASTIC ATHLETICS MUST HAVE THIS ALTERNATE YEAR CARD ON FILE AT THEIR SCHOOL PRIOR TO PRACTICE OR PARTICIPATION.
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* Indicates required question
24-25 School Year:
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Your answer
Student First Name:
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Your answer
Student Last Name:
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Your answer
Student Grade:
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Your answer
Date of Birth:
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MM
/
DD
/
YYYY
Present Address:
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Your answer
Telephone Number:
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Your answer
Parent's Place of Employment
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Your answer
Family Physician:
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Your answer
Family Dentist:
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Your answer
Name of Private Insurance Carrier:
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Your answer
Private Insurance Carrier Telephone Number:
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Your answer
Subscriber Member Name (Primary Insured):
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Your answer
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