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EMS Athletics - Registration and Medical Form
*
Indicates required field
Student-Athlete Name
*
First
Last
DOB (MM/DD/YEAR)
*
Care Card #
*
Student-Athlete Email Address
*
Use Parent's if Necessary
Sport
*
Select One
Cross Country
Football
Swimming
Boys Soccer
Boys Volleyball
Girls Volleyball
Boys Basketball
Girls Basketball
Curling
Wrestling
Golf
Boys Rugby
Girls Rugby
Girls Soccer
Track & Field
Ultimate
Ice Hockey
Water Polo
Team Level
*
Select One
Grade 8
Grade 8/9
Grade 9
Junior
Senior
Year Entered Grade 8
*
Previous High School
*
Only if applicable
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).
*
Please place N/A in the box if it does not pertain to you.
List any medications you are currently taking.
*
Please place N/A in the box if it does not pertain to you.
List any past physical injuries or medical conditions you have.
*
Please place N/A in the box if it does not pertain to you.
Have you ever been diagnosed with a concussion? When? Have you been cleared for participation in sport?
*
Submit
Home
Spring Season Info
Athletics Schedule
Documents
Contacts
Facility Schedule
Teams
Fall Programs
>
Cross Country
Swimming
Boys Soccer
Girls Volleyball
Boys Volleyball
Football
Winter Programs
>
Curling
Wrestling
Girls Basketball
Boys Basketball
Ice Hockey
Spring Programs
>
Girls Soccer
Golf
Girls Rugby
Boys Rugby
Track and Field
Ultimate Frisbee
About
Links
Photo Gallery