HP Intramural Sports - Emergency Form
Please complete prior to participating in intramural sports.  Thank you!
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Student First Name *
Student Last Name *
Student ID *
Grade *
Sport(s) *
Indicate which sport (or sports) you are interested in participating in.
Required
Parent First Name *
Parent Last Name *
Parent Email *
Parent Phone Number *
Other Phone Number (optional)
Other Phone Number (optional)
Emergency Contact (beside parent listed above) - First Name *
Emergency Contact (beside parent listed above) - Last Name *
Emergency Contact (beside parent listed above) - Phone Number *
Name of Medical Insurance *
Medical Number
Digital signature for consent to participate- Please type your name below. *
Digital signature for consent to participate- Please enter the date below. *
MM
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