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South Shore Christian AcademyFor Christ. For Others.

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Athlete Information Form

Please complete the form below. Required fields marked with an asterisk *

Student Information

Gender*
Answer Required
Fall Sports you intend to participate in:
Answer Required
Winter Sports you intend to participate in:
Answer Required
Spring Sports you intend to participate in:
Answer Required

Parent/Guardian Information

Emergency Contact

Medical Information

Family Physician

Family Dentist

Insurance Information

Although we are always greatly concerned about the safety and quality of our programs, occasionally, a student athelete will be injured and require medical attention.  For this reason, all students participating in athletics MUST carry insurance.  Please make sure to include the policy number below.

Did you purchase Student Accident Insurance?
Answer Required
If YES, please indicate the coverage type
Answer Required

Injury/Concussion

Has student ever experienced a traumatic head injury (a blow to the head)?
Answer Required
Has student ever received medical attention for a head injury?
Answer Required
If YES, was student diagnosed with a concussion?
Answer Required
Has student had a baseline test?
Answer Required
Confirmation Email