BHS MTB 2020 Roster/Emergency Contact/Medical Questionnaire



Please fill out form if you are a student, volunteer, ride leader, or coach. Medical information will be kept confidential.
Email address *
Rider Type
First Name *
Your answer
Last Name *
Your answer
Student ID *
Your answer
Are you a returning rider? *
Gender
Date of Birth *
MM
/
DD
/
YYYY
Phone Number *
Your answer
Address *
Your answer
Rider Email *
Your answer
Grade *
Parent/Emergency Contact 1 *
Name
Your answer
Phone Number *
Your answer
Email *
Your answer
Parent/Emergency Contact 2 *
Your answer
Phone *
Your answer
Email *
Your answer
Non-Parent Emergency Contact
Your answer
Phone
Your answer
Medical Conditions *
Write "None" if no relevant conditions
Your answer
Allergies *
Write "None" if no allergies
Your answer
Medication Needed on Rides *
Write "None" if no medication needed
Your answer
Other Information
Anything that would help us keep riders safe and having fun!
Your answer
Jersey Size *
Bib/Short Size *
A copy of your responses will be emailed to the address you provided.
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