Abby Kelley Foster Fall Athletic Registration
Please complete the following form and submit. Please note that in addition to this form your son/daughter must have have a current physical exam on file in the nurses office. The physical is valid for 13 months from the date of the physical . All students must have a valid physical in order to participate in the athletic program.

User fees for the Fall must be paid by Sept 6, 2019.

I, the undersigned parent/guardian/legal representative of the listed student do hereby consent to his/her participation in voluntary athletics, extra-curricular activities, and/or trips, and in consideration of his/her being permitted to so participate, I, on behalf of myself, my heirs, my agents, my representatives, and on behalf of the listed student do forever RELEASE, acquit, discharge, and covenant to hold harmless Abby Kelley Foster Charter Public School, and its employees, servants and agents, its former and current members, and its employees, servants and agents, from any and all actions, rights of actions, causes of action, charges, and/or claims, in any way related to, arising from and/or growing out of, directly or indirectly, all known personal injuries or property damage or death, which I may now or hereafter have as the parent/guardian/legal representative of said minor, as well as any actions, rights of action, causes of action, charges, and/or claims which said minor has or hereafter may acquire, either before or after he/she reaches the age of majority, resulting from, relating to, or in any way connected to, his/her participation in athletics, extra-curricular activities and/or trips run by, sponsored by or related to Abby Kelley Foster Charter Public School.

In addition, I, as parent/guardian/legal representative of said minor, agree to indemnity Abby Kelley Foster Charter Public School, and its employees, servants, and agents, its former and current members, and its employees, servants and agents, in the event that any action, charge, and/or claim, is brought against the foregoing, which in any way related to, arising from and/or growing out of, directly or indirectly, my son/daughter's participation in athletics, extra-curricular activities and/or trips run by, sponsored by or related to Abby Kelley Foster Charter Public School.

Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's Grade *
Parent/Guardian First Name *
Your answer
Parent/Guardian Last Name *
Your answer
Parent's e-mail address *
Your answer
Sport (Only select ONE (1) Sport) *
Parent's Home Phone *
Your answer
Parent's Cell Phone *
Your answer
Emergency Contact Name (in case parent can not be reached) *
Your answer
Emergency Contact Phone Number *
Your answer
Any pre-existing medical conditions? *(Example: Allergies, asthma, etc If none type "NONE" ) *
Your answer
Has student ever experienced a traumatic head injury (a blow to the head) or received medical attention for a head injury? *
Has student ever been diagnosed with a concussion? *
If yes, please indicate the dates (month/year) and the duration of symptoms such as headache, difficulty concentrating, fatigue, etc for the most recent concussion)
Your answer
PARENT GUARDIAN: I have been provided education regarding concussions. If not STOP, and go back to the main ATHLETICS page and download the 'Guide to Concussions' in step 3 *
STUDENT-ATHLETE: I have been provided education regarding concussions. If not STOP, and go back to the main ATHLETICS page and download the 'Guide to Concussions' in step 3 *
PARENT GUARDIAN: By checking the 'I, Agree' box and submitting this form, you agree that the student-athlete named above has permission to participate in the above selected sport. *
Next
Never submit passwords through Google Forms.
This form was created inside of Abby Kelley Foster Charter Public School. Report Abuse - Terms of Service