Athletic Off-Campus Consent Form
Please complete this form to provide consent for student participation in off-campus athletic activities.
Participant's Full Name
*
First Name
Last Name
Participant's Date of Birth
*
 -
Month
 -
Day
Year
2 digit month, 2 digit day, 4 digit year
Date
Grade Level
*
Please Select
6th Grade
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Parent/Guardian Name
*
First Name
Last Name
Parent/Guardian Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
Parent/Guardian Email Address
*
example@example.com
Emergency Contact Name
*
First Name
Last Name
Emergency Contact Phone Number
*
Please enter a valid phone number.
Format: (000) 000-0000.
List any allergies, medical conditions, or medications the participant has
*
Health Insurance Provider & Policy Number (if applicable)
Athletic Activity or Event Name
*
Date(s) of Off-Campus Activity
*
Transportation Method (select all that apply)
*
School Bus
Charter Bus
Private Vehicle
Other
Parent/Guardian Signature
*
Submit Consent
Submit Consent
Should be Empty: