Athletic Registration Form 2021-2022
Please complete the following student athletic registration form for the 2021 - 2022 school year. Please note, if you have multiple children you will need to fill out a separate form for each student athlete. The information collected on this form is confidential, and will not be shared with any outside agency. The information will be used for the purpose of meeting WIAA and DPI requirements for students to participate in middle and high school athletics. The following forms are included as part of this on-line registration process: Concussion Form, WIAA Eligibility Form, and Athens Co-Curricular Code.
Any questions please contact Craig Diedrich, Athletic Director at 715-257-7511 x131 or
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Student First Name *
Student Last Name *
Student Grade *
Student Gender *
Student Date of Birth *
Student Current Age *
Month and Year of Last Physical (all students are required a physical card or alternate year card on file at the high school office) *
Sport the student intends to participate in during the fall season *
Sport the student intends to participate in during the winter season *
Sport the student intends to participate in during the spring season *
Parent First Name *
Parent Last Name *
Current Address *
Parent Telephone (best contact number) *
Parent Email *
Parent Place of Employment *
Family Physician *
Family Dentist *
Name of Private Insurance Carrier *
Insurance Carrier Telephone *
Subscriber Member Name (Primary Insured) *
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