Girls Basketball
Sport experience providing instruction, character education, game play & FUN
Student First Name *
Your answer
Student Last Name *
Your answer
Grade for 2018-19 School Year (Current) *
Elementary School *
October 8 through October 25
Practice at School site, Games at Cheyenne Mountain High School
Parent Guardian Name (Last, First) *
Your answer
Parent Guardian Mobile Number *
Your answer
Parent Guardian Email *
Registration confirmation sent to this email
Your answer
Emergency Contact Name (Last, First) *
Your answer
Emergency Contact Mobile Number *
Your answer
Allergies/ Special needs *
Your answer
Please indicate any plans your child may have: *
Required
Consent to participate/Medical release/Waiver:
In the event of illness or injury to my son/daughter/ward, I give permission to any licensed physician to give him/her such medical treatment as they may consider necessary for his/her health or safety. I authorize the intramural director or his designee to seek such treatment on my behalf. I hereby further agree to defend, indemnify, save and hold harmless the Cheyenne Mountain School District, its employees, agents, and directors, as well as the staff of CMSD 12 Intramurals, from and against any claim for any claims, damages, or injuries which may result from my child’s participation in the activity, and furthermore agree to waive any claims my child or my family may have against the School District for losses, damages, or injuries which may result from my child’s participation in the above activity.
Please type your name, serving as electronic signature for the waiver above *
Your answer
Financial assistance is available for families who qualify for free and reduced price meals in the 2018-2019 school year. If you would like to be considered for financial assistance please contact Pam Cox at 719-475-6100, or cox@cmsd12.org.
Submit
Never submit passwords through Google Forms.
This form was created inside of Cheyenne Mountain School District 12. Report Abuse - Terms of Service