St. Luke Basketball Registration Form 2016-2017

St. Luke Basketball Registration Form 2016-2017 Girls – grades 7-8 Registration forms and fees are due on October 7. Uniform sizing samples will be avail able—see email. Please make checks payable to St. Luke Athletics.

 Yes! I need to order a new uniform that my child will keep. Fee: $215 (circle sizes below) Jersey (circle): YM YL women’s S women’s M women’s L women’s XL Shorts (circle): YM YL XYL women’s S women’s M women’s L women’s XL

 My 8th grader is reusing last year’s uniform # _____ (their jersey #) Fee: $135

FAMILY INFORMATION Student Name: ______Grade: ______

Address: ______Town: ______

Parent /Guardian Name(s): ______Home Phone: ______

Email address: ______Cell Phone:______

Alternate Emergency Contact: ______Phone: ______

Participation Authorization / Release I hereby consent to my child’s participation in this program in accordance with the rules/policies stated in the St. Luke Athletic Handbook, as amended. I hereby further agree to release, indemnify and hold harmless St. Luke Parish School and the Athletic Committee, their employees, agents, coaches and volunteer drivers from any and all claims arising out of injury to my child as a result of his/her participation in this program. Parent/Guardian Signature: ______Date: ______

MEDICAL INFORMATION: Physician: ______Phone: ______Allergies or other conditions: ______

INSURANCE INFORMATION: Insurance Company: ______Policy in the name of: ______Policy No.: ______

Medical Permission Authorization I grant permission for the administration of first aid to my child by the person(s) in charge of the St. Luke athletic events and those providing transportation to my child to and from the events as in his/her /their judgment seems advisable, and to make the necessary referrals to qualified physicians for treatment of illnesses or accidents that may arise in connection with my child’s participation. I understand that I will be promptly notified in the event of any serious illness or accident and prior to any major surgery, except when delay in such communication would endanger life. In case of medical emergency I understand that every effort will be made to contact the parent/guardian of the participant. In the event I cannot be reached, I hereby grant permission to the attending physician to hospitalize, secure proper treatment, and order injection, anesthesia and/or surgery, if deemed necessary, for my child. Parent/Guardian Signature: ______Date: ______

Please return this form and fee (payable to St. Luke Athletics) to the school office, attention Athletic Director. Questions? Please email Anna Dooley at [email protected] or at 773.771.1092.

Thanks to funding provided by generous donations to the St. Luke 500 Club and athletics program, athletic fee scholarships are available. For information about these scholarships, contact Anna Dooley.