Purcell Public Schools - Athletic Forms
These forms are the legal documents that must be filed with the school in order to participate in extracurricular activities.

Instructions:
Typing your name and clicking the "submit" you have agreed to a binding electronic signature.

The online registration process should be viewed and discussed with your student-athlete. Please complete this form with your student-athlete present.

Also, families with multiple students must complete one online registration process for each of their students.

**This form, signature card and a physical must be on file in the Athletic Office prior to participating (tryouts, practice and/or contests) in Purcell High School athletics.

NOTE: This is a secured form (https).

Student Athletes Name *
Last Name
Your answer
*
First Name
Your answer
Student/Athletes Date of Birth *
00/00/0000
Your answer
Student Email Address
Your answer
Student Athlete Cell Phone # *
000-000-0000
Your answer
Gender *
Grade in School *
2017/2018 school year
Mailing Address *
Street/PO Box
Your answer
*
City
Your answer
*
Zip Code
Your answer
Parent/Guardian 1: *
Name
Your answer
*
Cell Phone 000-000-0000
Your answer
*
Home Phone 000-000-0000
Your answer
*
Work Phone 000-000-0000
Your answer
Parent/Guardian Email Address
Your answer
Parent/Guardian 2:
Name
Your answer
Cell Phone 000-000-0000
Your answer
Home Phone 000-000-0000
Your answer
Work Phone 000-000-0000
Your answer
Parent/Guardian Email Address
Your answer
Emergency Contact Name & Number *
Another name & number to contact in case of emergency
Your answer
New student to Purcell Public School District 2017/18 school year *
My Son/Daughter will be involved in the following activities. *
Check all that apply
Required
PURCELL PUBLIC SCHOOLS EXTRA-CURRICULAR DRUG TESTING POLICY
By checking the box I acknowledge that I have read and understand the Purcell School Districts Activity Drug testing policy. *
Required
Student Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Medication List
List any substances, drugs or medications that student is currently taking or has taken in the last 30 days.
Your answer
By checking the box I acknowledge that I have read and understand the Purcell School Districts Concussion & head Injury Acknowledgement.. *
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Student Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Insurance Verification
Check the appropriate blank *
Required
Name of Insurance
Your answer
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Rider/Driver Forms
If you are the parent of a 7th or 8th grade student answer no to all the rider driver questions.
PARENTAL AUTHORIZATION TO TRANSPORT STUDENTS IN PERSONALLY-OWNED VEHICLES *
As parent/guardian of the above student who is licensed to drive a motor vehicle in the state of Oklahoma, I give my son/daughter permission to drive to extra-curricular sites in our district and to transport other secondary students in the same vehicle to practice sites. I realize and accept the liability I incur by allowing my child to transport other students in my vehicle. I also understand that the school district is providing transportation to practice sites and is not liable for any accidents or situations which may occur as a result of the operation of a vehicle by my child transporting other students to practice sites. As the parent/legal guardian I can revoke this authorization at any time by notifying the building principal in writing.
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
PARENTAL AUTHORIZATION TO RIDE WITH OTHER STUDENT DRIVERS *
As parent/guardian of the above student, I give my son/daughter permission to ride to extra-curricular practice sites with other students who are licensed to drive to these practice sites. l realize the school is providing transportation to the practice sites and will not be liable for any accidents or situations involving my child being transported by another student. I may revoke this authorization at anytime by notifying the building principal in writing.
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Athlete/Parent/Guardian Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet and Acknowledgement of Receipt and Review Form
By checking the box I acknowledge that I have read and understand the Athlete/Parent/Guardian Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet and Acknowledgement of Receipt and Review Form *
Required
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
Student Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
The above information is correct to the best of my knowledge. I hereby give my informed consent for the above-mentioned student to participate in activities. I understand the risk of injury in athletic participation. If my son/daughter becomes ill or is injured, necessary medical care can be instituted by physicians, coaches, trainers or other personnel properly trained.
Parent/Guardian Signature *
By typing your name below, You agree that this is valid as your signature.
Your answer
We have completed the online Athletics Registration form, and signed electronically by typing our names in the fields provided and clicking on "submit" below, we agree that our typed name is a binding electronic signature. The date and time that the document, is signed and tracked, and an electronic version of the document is stored within the system at Purcell Schools.
Submit
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