Saint Francis of Assisi Cyo

SAINT FRANCIS OF ASSISI Junior CYO REGISTRATION FORM

CYO Registration Fee - $20.00 per year/per family Individual Sport Participation Fee - $55.00 per child

LAST NAME FIRST NAME

DATE OF BIRTH GRADE SCHOOL*

ADDRESS CITY ZIP

HOME PHONE MOTHER/GUARDIAN CELL FATHER/GUARDIAN CELL

MOTHER/GUARDIAN EMAIL FATHER/GUARDIAN EMAIL *If the school your child attends is other than Saint Francis, he/she must attend CCD.

INSURANCE CARRIER POLICY # POLICY HOLDER GROUP # Hospital Preference Family Doctor Ph# Allergies/Medications

Does your child have? EAR/NOSE CONDITION ____YES ____NO Date of Last EPILEPSY ____YES ____NO Tetanus booster? DIABETES ____YES ____NO ASTHMA ____YES ____NO IF YOU ANSWERED YES TO ANY OF THE ABOVE, PLEASE PROVIDE A NOTE FROM YOUR DOCTOR SAYING PARTICIPATION IS SAFE FOR YOU CHILD.

In the event of an emergency, I hereby give permission to St. Francis CYO and /or the coaching staff of St. Francis to secure proper emergency treatment from a physician or to take my child to the closet hospital for emergency treatment, or to ______Hospital only

PARENTS SIGNATURE ______

PARENT’S RELEASE

In consideration of my/our child ______being allowed to participate in CYO activities and competitive sports, I/we hereby release and forever discharge St. Francis of Assisi in Norristown, PA, the coaching staff and activity volunteers at SFA from any and all liability, in law or equity, which I/we or my/our child may have, or hereafter have, by reason of personal injuries or property damages, sustained by my/our child while participating in CYO activities or sports or in transit to of from participation in same.

Date – Parent/Guardian Signature

CYO PHOTO RELEASE This form, once signed and returned to a CYO board member or coach, will enable us to photograph your child during various sporting events, service projects and social events that will take place throughout the year. Signature of Parent/Guardian: Date: