26/27 Basketball Registration Revised

Family Address

Street Address

Street Address Line 2

CityState / Province

Postal / Zip Code

How many Students are you registering?

First Student Full Name

First NameLast Name

First Student Grade

First Student Gender

First Student Shirt Size

DOB

Date

Second Student Full Name

First NameLast Name

Second Student Grade

Second Student Gender

Second Student Shirt Size

DOB

Date

Third Student Full Name

First NameLast Name

Third Student Grade

Third Student Gender

Third Student Shirt Size

DOB

Date

Fourth Student Full Name

First NameLast Name

Fourth Student Grade

Fourth Student Gender

Fourth Student Shirt Size

DOB

Date

Please fill out all that apply (must include emergency contact)

Mother/Guardian Full Name

First NameLast Name

Mother/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Mother/Guardian Email Address

example@example.com

Father/Guardian Full Name

First NameLast Name

Father/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Father/Guardian Email Address

example@example.com

Emergency Contact

First NameLast Name

Emergency Contact Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Emergency Contact Email

example@example.com

Emergency Contact Relationship

Student Athlete Medical History (must fill out for each student)

Student One Physician Name

First NameLast Name

Student One Physician Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Student One Preferred Medical Facility

Student One: Please answer the questions accordingly:

Rows	Yes	No
The athlete have any chronic medical conditions or illnesses?
The athlete presently taking any medications?
The athlete have any allergies?
The athlete ever had a head injury, or had a concussion?
The athlete ever had a heat injury or severe muscle cramps with activities?
The athlete ever passed out or fainted during exercise?
The athlete ever had extreme fatigue with exercise?
A doctor ever told the athlete that they have high blood pressure?
The athlete ever sprained/strained, dislocated, fractured, broken or other injury?
The athlete ever been hospitalized or had surgery?

Student One: If, you have answered as a "Yes" at least one of them, please give details

Student Two Physician Name

First NameLast Name

Student Two Physician Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Student Two Preferred Medical Facility

Student Two: Please answer the questions accordingly:

Rows	Yes	No
The athlete have any chronic medical conditions or illnesses?
The athlete presently taking any medications?
The athlete have any allergies?
The athlete ever had a head injury, or had a concussion?
The athlete ever had a heat injury or severe muscle cramps with activities?
The athlete ever passed out or fainted during exercise?
The athlete ever had extreme fatigue with exercise?
A doctor ever told the athlete that they have high blood pressure?
The athlete ever sprained/strained, dislocated, fractured, broken or other injury?
The athlete ever been hospitalized or had surgery?

Student Two: If, you have answered as a "Yes" at least one of them, please give details

Student Three Physician Name

First NameLast Name

Student Three Physician Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Student Three Preferred Medical Facility

Student Three: Please answer the questions accordingly:

Rows	Yes	No
The athlete have any chronic medical conditions or illnesses?
The athlete presently taking any medications?
The athlete have any allergies?
The athlete ever had a head injury, or had a concussion?
The athlete ever had a heat injury or severe muscle cramps with activities?
The athlete ever passed out or fainted during exercise?
The athlete ever had extreme fatigue with exercise?
A doctor ever told the athlete that they have high blood pressure?
The athlete ever sprained/strained, dislocated, fractured, broken or other injury?
The athlete ever been hospitalized or had surgery?

Student Three: If, you have answered as a "Yes" at least one of them, please give details

Student Four Physician Name

First NameLast Name

Student Four Physician Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Student Four Preferred Medical Facility

Student Four: Please answer the questions accordingly:

Rows	Yes	No
The athlete have any chronic medical conditions or illnesses?
The athlete presently taking any medications?
The athlete have any allergies?
The athlete ever had a head injury, or had a concussion?
The athlete ever had a heat injury or severe muscle cramps with activities?
The athlete ever passed out or fainted during exercise?
The athlete ever had extreme fatigue with exercise?
A doctor ever told the athlete that they have high blood pressure?
The athlete ever sprained/strained, dislocated, fractured, broken or other injury?
The athlete ever been hospitalized or had surgery?

Student Four: If, you have answered as a "Yes" at least one of them, please give details

Are you interested in being a coach or assistant coach? Athletic Coordinator should contact:

Mother/Guardian Full Name

First NameLast Name

Mother/Guardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

Father/Guardian Full Name

First NameLast Name

FatherGuardian Phone Number

Please enter a valid phone number.Format: (000) 000-0000.

In consideration for my child/ward’s participation, I agree to reimburse and indemnify the parish/school for all reasonable legal and court fees incurred by parish/school in defending a lawsuit that I or my child/ward may bring against the parish/school Which relates to the above named activity if the parish/school is found not legally liable by the courts and prevails in the lawsuit. If the parish/school is found legally liable for injuries sustained by child/ward, this paragraph will not apply.

I certify that I have an understanding of this agreement and any risks and hazards associated with the activity described above that my child/ward will be participating in. I further understand that I had the opportunity to fully discuss this agreement with a representative of the parish/school to clarify any concerns or questions about the activity or this agreement that I may have had.

Parent/Guardian Consent

In the event of an emergency, I give permission to transport my child to a hospital for emergency medical treatment. I wish to be advised prior to any further treatment by the hospital or doctor.

On field trips that occur during the length of the school day, any prescription medication already provided to the school will be carried and administered by staff.

If we are unable to reach you at the above number provided, please an alternate emergency contact below:

Medical Parent/Guardian Consent

Parent/Guardian Signature

Date Signed

Date

You must select the total quantity of students below. This form does not auto calculate. The cost of registration is $104 per student.

You must issue payment to complete this form.

Please contact helpdesk@ourbcs.org for assistance

BCS Athletics Registration

Basketball Registration Fee

$104.00 Quantity

Enter coupon

Total

Payment Methods

Debit or Credit Card

Choose from one of the PayPal options to make your payment.

BCS Athletics

Parent/Guardian Contact Information

Student Athlete Medical History

Coach or Assitant Coaching

Permission and Consent

Athlete Registration Fees

BCS Athletics Registration

Payment Methods

BCS Athletics

Parent/Guardian Contact Information

Student Athlete Medical History

Coach or Assitant Coaching

Permission and Consent

Athlete Registration Fees

BCS Athletics Registration*

Payment Methods

BCS Athletics Registration