2020 Gael Scoil Registration
Medical/Emergency Contact/Parental Consent Form
Notre Dame High School
Lawrenceville, NJ

Cost: Reduced cost of $75 per student

Student Information
Student's Name *
Your answer
Birth Date *
MM
/
DD
/
YYYY
Shirt Size
Parental Consent
Parent's Name
Your answer
Email Address (required) *
Your answer
Mobile Phone (required) *
(xxx) xxx-xxxx
Your answer
Alternate Phone
(xxx) xxx-xxxx
Your answer
Relationship (i.e. Mother, Father, Guardian...)
Your answer
Address
Your answer
Medical
Physician
Name of student's physician to be contacted in an emergency if parent/guardian is unavailable.
Name
Your answer
Day Phone
(xxx) xxx-xxxx
Your answer
Does your child require and special accommodations?
small group setting, one-on-one assistance, physical accommodations, etc.
If yes, please explain
Your answer
If your child is allergic to bee stings, does he/she need
Details
Your answer
Does your child have one of these common allergies?
Any additional special medical concerns
Any special medical concerns or dietary information that is important for us to know not already listed on this form? For example; other allergies, asthma, seizures, diabetes, ADHD, medications, special conditions? Any special activities in which your child should not participate?
Your answer
Legal
After school my child will be
If picked up, my student will be picked up by
Name of adult authorized to pick up your child. Separate names with commas if more than one.
Your answer
After school my student CAN NOT be picked up
Your answer
Consent - All fields in this section MUST be completed or your registration will not be accepted.
Parent/Guardian electronic signature is required for item below to indicate consent. A physical signature will be collected at registration the first morning of classes.
I consent to allow my child medical care if necessary
Please enter I AGREE on the next line to consent
Your answer
I consent to allow my child minor first aid procedures if necessary
Please enter I AGREE on the next line to consent
Your answer
I have read and understand this form. I agree to indemnify and hold harm-less Notre Dame High School, Gael Scoil, the Ancient Order of Hibernians, their officers, directors, agents and staff. *
Please enter I AGREE on the next line to indicate your agreement
Your answer
Your Name
Your answer
Submit
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