Scullen Athletics Google Registration
Please fill out all fields and click submit to send this form confidentially to Scullen coaches.
Athlete Last Name *
Your answer
Athlete First Name *
Your answer
Grade Level and Gender *
Sport *
What sport are you participating in? (check all that will potentially apply)
Required
Parent/Guardian Name *
Your answer
Parent/Guardian Email One *
Your answer
Parent/Guardian Phone Number One *
Your answer
Parent/Guardian Email Two *
Your answer
Parent/Guardian Phone Number Two *
Your answer
Address *
Street, City, Zip
Your answer
Is a physical exam on file with the school nurse? *
All students trying out/practicing for a sport must have a current physical exam on file with the school nurse. A current physical exam is one that has been completed within TWELVE months of the last day of the season. Physicals are valid for one calendar year.
Medical concerns to be shared with the coaches: *
Your answer
Is your student covered under a school insurance policy? *
If not, your digital signature constitutes a waiver and a confirmation of other insurance coverage: *
Please include the insurance company and the policy number:
Your answer
Emergency Contact One *
Name
Your answer
Emergency Contact One Phone Number *
Your answer
Emergency Contact Two *
Name
Your answer
Emergency Contact Two Phone Number *
Your answer
Emergency Contact Three
Name (Optional)
Your answer
Emergency Contact Three Phone Number
(Optional)
Your answer
Have you paid your athletic fee to your coach? *
Activity fees are $125 per sport (maximum charge is $250.00, regardless of the number of sports or activities in which the student is involved).
All students will be required to maintain passing grades in order to participate. *
Three strike rule: 1st strike is a warning, 2nd strike is no games, 3rd strike is no games and no practice until the grade is passing.
Have you read and agree to the terms within the athletic eligibility requirements? *
The athletic eligibility requirements can be found on the athletics page by going to this site: https://drive.google.com/file/d/0B5JdUFXDa3iyd0FucXBuX1YyVVk/edit?usp=sharing
Have you read and agree to the terms within the district concussion form agreement? *
Digital Signature of Parent/Guardian *
Please type in the first and last name of the parent/guardian that is filling out this form. This constitutes written permission to participate in the Middle School Athletic Program and understand the inherit risk involved.
Your answer
Submit
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