Cross Country Sign-Up-L.B. Clarke Middle School
If you are interested in signing your student up for the 2020 cross country season, please fill out this information. More information on practice times, meet schedules, etc. will follow. We look forward to running with you!
Email address *
Student Name *
Student Grade Level *
Parents/Guardians Name(s) *
Parents/Guardian Phone Number *
Alternative Emergency Contact and Phone Number *
Current Medications *
Known Allergies *
Insurance Company Name *
Group Number *
Policy Number *
Family Physician *
Physician Phone Number *
Dentist Name *
Dentist Phone Number *
As a parent/guardian of your student, you give permission to the coach, athletic trainer, and/or emergency personnel to treat my student deemed necessary. *
I have read and agree to the concussion protocol ( that is in place for the Two Rivers Public School District. *
My student and I have read and agree to the co-curricular code( of L.B. Clarke Middle School. *
I have paid my sports fee of $20 for this sports season through RevTrak ( *
Parent/Guardian Signature (Please type name) *
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