Saint Rita of Cascia School

Challenging the Mind ~ Nurturing the Spirit

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Football

- Athletics

Football Registration
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- PARENTS' INFORMATION
- I am the child's
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- City REQUIRED Please fill out this field. Please enter valid data.
  
  State REQUIRED Please fill out this field.
  
  Zip REQUIRED Please fill out this field. Please enter a zip code.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Email REQUIRED Please fill out this field. Please enter an email address.
- My Child's Health Insurance Coverage is Provided by: Private Health Insurance All School Health Insurance through St. Rita
- The Name of my Health Insurer and Policy Number is:
  If covered by private insurance, please provide the name of your health insurer and policy number here.
  Please enter valid data.
- Policy Holder's Name REQUIRED Please fill out this field. Please enter valid data.
- STUDENT'S INFORMATION
- Name of Student/Athlete
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Gender REQUIRED Please fill out this field.
- Grade REQUIRED 5th Grade 6th Grade 7th Grade 8th Grade Please fill out this field.
- Sports Physical was Completed on the Following Date: REQUIRED
  Per league and Diocesan rules, a student is not allowed to participate until the sports physical has been completed and turned into the school office. A physical is valid for a period of 12 months.
  Please fill out this field. Please enter a date.
- Please list any and all medical information/conditions. (If none please state n/a.) REQUIRED Please fill out this field.
- Name of Student's Pediatrician REQUIRED Please fill out this field. Please enter valid data.
- Pediatrician's Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Football Fee Acknowledgment
- I understand that St. Rita school does not have its own football team and that my child will be placed on another team, with all other St. Rita students, within the Aurora Catholic League. I further understand that St. Rita school does not set the football fee but rather, said fee is set by the host school that my child will be joining. As a guide, I understand that in years' past the fee for football has been in the range of $150 to $250 per student, but does vary from year to year.
  
  I understand that payment of this participation fee is my responsibility and not that of St. Rita school. I agree to these terms.
  I Agree Please select this field.
- EMERGENCY CONTACT AND PERMISSION TO TREAT
- Emergency Contact
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Phone Number REQUIRED Please fill out this field. Please enter a phone number.
- Relationship of Emergency Contact Please enter valid data.
- Permission to Treat in an Emergency
- During athletic competition, there are situations that sometimes arise where a student/athlete may require emergency medical attention.
  
  In the event we cannot be reached to obtain permission for medical attention, by clicking "I Agree" below, I hereby authorize St. Rita school, youth program volunteers, and/or its authorized agent and employee representative(s) to act for me in an emergency or other circumstance requiring any medical treatment or attention on behalf of my child without any further permission. This consent and authorization shall include, but not be limited to, obtaining necessary hospital, medical, surgical, dental, optical, pharmaceutical, and any related care for my child and to sign any authorization therefore including admissions and/or discharges from any hospital or other care facility. I also agree to assume financial responsibility for all costs associated with medical treatment and/or transportation.
  
  St. Rita staff will make every effort to reach the provided emergency contacts in the event of a medical issue. In most cases, parental permission will be obtained before providing treatment, especially in nonemergency situations.
  I Agree Please select this field.
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