PCS Fall Sports Registration
Athlete's First & Last Name *
Your answer
Athlete's Date of Birth *
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Grade *
Sport Selection *
Required
Uniform Sizes:
*Does not guarantee size will be assigned
SHIRT size *
Short Size *
For soccer only, please list shoe size (specify adult/ladies/youth) so we can purchase the correct socks.
Your answer
Email for Communication from Coaches *
Your answer
Secondary email
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Phone Number *
Your answer
Father's Cell Number *
Your answer
Mother's Cell Number *
Your answer
Name of insurance company *
Your answer
Name of policy holder *
Your answer
Policy number *
Your answer
Athletes's allergies, medications, medical conditions (if none, please write "none"): *
Your answer
Does the student wear contact lenses? *
Please list date of last tetanus shot *
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Check any medications we should NOT provide upon request:
Please list any dates--along with a brief reason why--you will need to miss a practice or a game during the season (August 5th-October 29). *Example: Aug. 5-10; vacation* If none, please write "none." *
Your answer
Consent and Commitment
By my electronic signatures below, I agree to the following:
As parent, I allow my child to participate in PCS athletic activities. The student and parents recognize that participation in athletics involves risks for severe injuries or death and serious injury or impairment to other aspects of the body, and impairment to the general health and well-being of the child. The student and parent, individually and on behalf of the student, hereby irrevocably, and unconditionally release, acquit, and forever discharge Providence Classical School and its officers, agents, representatives, affiliated companies, volunteers, and employees (collectively, the "Releasees") from any and all losses, claims, actions, obligations, damages, and costs of any nature (including attorney’s fees) that the student or parent incur or sustain to person or property, which arise out of or are otherwise connected with the student’s participation in athletics. I also reaffirm my agreement to the Providence Classical School Release Form, which applies to all school activities. I am aware that participating in sports may involve travel with the team. I acknowledge and accept the risks with the travel involved and with this knowledge in mind, grant permission for my child to travel with the team. *
Your answer
I hereby consent to the medical treatment of my child in an emergency where I am not present or not immediately available to consent to such treatment. *
Your answer
I (and my child) have read and understand the Athletics Handbook. Joining a team is a commitment to my teammates, coaches, and the school, and we agree to the parent and student responsibilities in the Athletics Handbook. *
Your answer
Date *
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