Athletic Registration Form & Emergency Info
This form must be completed once per sport season before the child's first practice.  One form per child.  Thank you!

Registration fee of $125 per sport. Invoices will be sent through FACTS after registration closes. 

Fee of $60 will occur if the uniform is not returned by the end of season.



NOTE:  If any information changes, please submit a new form immediately.
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Athlete Information
Athlete's First Name *
Athlete's Last Name *
Birthdate *
MM
/
DD
/
YYYY
Gender *
Sport Interest *
Athlete's Grade *
Athlete's T-Shirt Size *
Parent Information
Father/Guardian Name *
Father/Guardian Phone- format: 541-555-5555 *
Father/Guardian E-Mail *
Mother/Guardian Name *
Mother/Guardian Phone- format: 541-555-5555 *
Mother/Guardian E-Mail *
Emergency Contact Name *
Relationship to Athlete *
Emergency Contact Phone Number- format: 541-555-5555 *
Medical Information
Family Physician *
Phone Number- format: 541-555-5555 *
Insurance Company *
Policy Number *
Medical Conditions *
Current Medicines *
Athletic Participation Agreement
Regarding Health Insurance *
I / we understand that Eugene Christin School does not provide medical insurance for student injuries.
Athletic Participation Fees *
By typing my full name below, I understand that payment of $125 per sport is required prior to the first official practice for each sport season.  I understand that a fee of $60 will occur if the uniform is not returned by the end of season. I understand that my child is not allowed to participate unless payment arrangements have been with the Middle School Athletic Director and/or School Administrator.  
Release From Liability *
With full understanding of the risks involved, I/we release and hold harmless my child's/ward's school, the school's against which it competes, the contest official and Eugene Christian School of any and all responsibility and liability for any injury or claim results from such athletic participation and agree to take no legal action against Eugene Christian School because of any accident or mishap involving the athletic participation of my child/ward. Please sign by typing your first and last name.
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