Registration and Medical Form

EMS Athletics - Registration and Medical Form

* Indicates required field

Student-Athlete Name *

First

Last

DOB (MM/DD/YEAR) *

Care Card # *

Student-Athlete Email Address *

Sport *

Team Level *

Year Entered Grade 8 *

Previous High School *

Parent / Guardian #1

Name *

First

Last

Phone Number *

Email *

Alternate Phone Number *

Parent / Guardian #2

Name *

First

Last

Email *

Phone Number *

Alternative Phone Number *

Alternative Contact

Name *

First

Last

Relationship *

Phone Number *

Alternative Phone Number *

Student-Athlete Medical History

List any allergies you may have (medical, environmental, food). *

List any medications you are currently taking. *

List any past physical injuries or medical conditions you have. *

Have you ever been diagnosed with a concussion? When? Have you been cleared for participation in sport? *

Submit

Our School Community

Earl Marriott is located in South Surrey and is one of 3 high schools on the Semiahmoo Peninsula. Our enrolment is consistently between 1900 and 2000 pupils, providing educational opportunities for students from one of the largest catchment areas in the Surrey School District. We are proud to offer a French Immersion program consisting of approximately 25% of our total student population. We look forward to hosting you on our newly renovated field or in one of our 3 gymnasiums!

All student-athletes must complete the online form found below before participation in sport at EMS. Please complete every season.

EMS Athletics - Registration and Medical Form

Parent / Guardian #1

Parent / Guardian #2

Alternative Contact

Student-Athlete Medical History

Where to Find Us

Our School Community

Contact