2021-2022 Athletic Acknowledgement Form
This form serves to provide verification of two important items related to the student-athlete handbook 2021-2022. Parents and athletes will complete this form together to verify receipt of the handbook (including content) and receipt of concussion guidelines, also included in the handbook.
Each participating athlete will need to complete this form or submit a printed and signed one to the Activities Director or Principal of your school:

Culpeper Middle School
Principal: Mr. Jesse Blackburn email jblackburn@culpeperschools.org
Please enter the athlete's Last Name: *
Please enter the athlete's First Name: *
Select Grade Level of the Athlete for the 2020-2021 School Year: *
Please enter the athlete's student ID number: *
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