CENTRAL JUNIOR HIGH ATHLETICS

REGISTRATION FOR SPORTS ACTIVITIES

Students Name: (Last) (First) (Middle Initial)

Name of Parent or Guardian

In Case of Emergency, Notify: Name, Address, Phone Number, Cell Number

Registering for the following Sport Activities: ___________________________ Grade______________________

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In order for your child to participate in extra-curricular athletics at Central Junior High, the following requirements must be met:

1. Have a current physical exam certifying physical ability to participate in the specific

activity on file in the school office.

2. Purchase hospitalization insurance provided through the school: or sign and return the

form below indicating that you want school insurance or you will provide your own

hospitalization coverage.

In order for my child to participate in extra-curricular athletics at Central Junior High School, Evergreen Park, Il.

__________ We will purchase hospital insurance through the school.

__________ We will provide our own hospitalization insurance.

(Name of Insurance Company)

Before your (son/daughter) first comes to practice. I would like to inform you that if selected for the school team, he/ she) must maintain the following criteria:

1. Good attitude and sportsmanship.

2. Work up to his/her scholastic level.

3. General behavior and citizenship above reproach.

4. Be able to participate in any games scheduled by the athletic department of this school and if necessary, to travel by approved transportation to the schools not in our district.

I hereby give permission to my son/daughter to participate in the above listed activity. If my son/daughter is injured in the activity, the personnel in charge will follow the procedure listed:

1. Attempt to call the parent or guardian listed above.

2. Attempt to call the emergency number listed above.

3. Call the local paramedic team.

_________________________________ _________________________________

(Parents Signature) (Date)

THIS FORM MUST BE FILLED OUT COMPLETELY AND RETURNED BEFORE THE FIRST PRACTICE!

IF YOU HAVE ANY QUESTIONS PLEASE CALL 708-424-0148

Coach or Sponsor ______________________________________________________________________