Athletics Registration

Parent/Guardian Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Email REQUIRED Please fill out this field. Please enter an email address.

Street Address 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.

Alternate Emergency Contact Information

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Relationship REQUIRED Please fill out this field. Please enter valid data.

Street Address 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.

Medical Information

Hospital/Clinic Preference REQUIRED Please fill out this field. Please enter valid data.

Physician’s Name REQUIRED Please fill out this field. Please enter valid data.

Physician's Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Insurance Company REQUIRED Please fill out this field. Please enter valid data.

Insurance Policy Number REQUIRED Please fill out this field. Please enter valid data.

Allergies/Special Health Considerations

I authorize all medical treatment performed or prescribed by the attending physician for my child and waive my right to informed consent or treatment. The waiver applies only in the event that neither parent/guardian can be reached in case of an emergency.

ELECTRONIC SIGNATURE AGREEMENT:
By typing my full name in the box below, I am signing this Agreement electronically. I agree my electronic signature is the legal equivalent of my manual signature on this Agreement. I consent to be legally bound by this Agreement's terms and conditions.

Signed REQUIRED Please fill out this field. Please enter valid data.

St. Hubert Catholic School

Impacting the world through Christ

Athletics Registration

4th-8th grade girls and boys basketball registration is closed

Registration Fees

Sport Physicals