Athletic Program for Grades 5-8 (2011-2012)

St. John the Evangelist Catholic School

Volleyball Registration/ Parent Permission Form/Medical Release

Volleyball season will begin immediately at the start of school in August.  Practices and games will be held on Mondays, Wednesdays and Fridays at the Streamwood Park District or at Canton Middle School in Streamwood.  The cost of the program this year will be $75 per student.  There will be no fundraising obligation, but each family will need to volunteer for at least one night helping with concessions, scoring and cleanup.  Also if you are interested in coaching a team please indicate on the form below.

Participant’s Name: _____________________________________________Grade: _________________

Address: _____________________________________________________________________________

Parents Names: _______________________________________________________________________

Home Phone: __________________________       E-mail: _____________________________________

Mom’s Cell: ___________________________       Dad’s Cell: __________________________________

Family Physician: __________________________________ Phone: _____________________________

Are you interested in coaching?    Circle:      YES         NO

PERSON TO CALL IN EMERGENCY IF PARENTS CANNOT BE REACHED:

Name: _____________________________________________ Phone: ___________________________

Relation to Participant: __________________________________________________________________

Known Medical Problems or Allergies: _____________________________________________

_____________________________________________________________________________

I, the undersigned, do hereby grant permission to the bearer of this note, to authorize emergency medical treatment for my son/daughter in the event that the persons listed above cannot be reached.  I release from all responsibility all duly authorized officials, coaches, and representatives of the St. John’s Sports Program in the event of accidental injury or death.

Parent/Guardian Signature: _________________________________________________

Registrants and participants permit the taking of photos and video of themselves and their children during program events for publication and use, and agree to permit the release of their names for photographs and stories for publication as the school deems appropriate.

Parent/Guardian Signature: _______________________________________________________