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 CYO ATHLETE FORM
QUEEN OF PEACE
CYO ATHLETE FORM
SPORT TO PARTICIPATE IN:____________________________________
CHILD’S NAME:_______________________________________________
AGE:_________ DATE OF BIRTH:________________
GRADE:____________________ SCHOOL:_______________________
PARENT/GUARDIAN___________________________________________
ADDRESS:_____________________________________________________
PHONE NUMBER:______________________________________________
PARENT’S CELL PHONE NUMBER:_______________________________
PARENT’S E-MAIL ADDRESS:____________________________________
IF PARENT IS NOT AVAILABLE IN AN EMERGENCY PLEASE NOTIFY:
1._____________________________________________________________
NAME …………………………. PHONE ………………………. RELATIONSHIP
2______________________________________________________________
NAME …………………………. PHONE …………………………. RELATIONSHIP
DOES YOUR CHILD HAVE ANY MEDICAL PRBLEMS OR ALLERGIES THAT WE SHOULD KNOW ABOUT?
YES__________________________ NO__________________
IF YES EXPLAIN:_______________________________________________
PARENT’S SIGNATURE:____________________________________________
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