2025-2026 Athlete Information Form

All students planning to play a sport during the 2025-2026 school year are required to fill out this form.

Student Information

First Name*

Answer required for "First Name"

Last Name*

Answer required for "Last Name"

Date of Birth*

Answer required for "Date of Birth"

Grade*

Answer required for "Grade"

Gender*

Answer required for "Gender"

Male

Female

Uniform Size*

Answer required for "Uniform Size"

Youth Small

Youth Medium

Youth Large

Youth XL

Adult Small

Adult Medium

Adult Large

Adult XL

Adult XXL

Fall Sports you intend to participate in:

Answer required for "Fall Sports you intend to participate in: "

Boys Soccer

Girls Volleyball

Winter Sports you intend to participate in:

Answer required for "Winter Sports you intend to participate in:"

Girls Basketball

Boys Basketball

Indoor Track (Co-Ed)

Spring Sports you intend to participate in:

Answer required for "Spring Sports you intend to participate in:"

Flag Football (Co-Ed)

Girls Soccer

Track & Field (Co-Ed)

Parent/Guardian Information

Name*

Answer required for "Name"

Relationship*

Answer required for "Relationship"

Day Phone*

Answer required for "Day Phone"

Emergency Contact

Name*

Answer required for "Name"

Relationship

Answer required for "Relationship"

Phone*

Answer required for "Phone"

Injury/Concussion

Each year, all students complete a concussion test, which is kept on file with the school nurse.

Has student ever experienced a traumatic head injury (a blow to the head)?

Answer required for "Has student ever experienced a traumatic head injury (a blow to the head)?"

Yes

If YES, when (Approximately)?

Answer required for "If YES, when (Approximately)?"

Has student ever received medical attention for a head injury?

Answer required for "Has student ever received medical attention for a head injury?"

Yes

If YES, when (Approximately)?

Answer required for "If YES, when (Approximately)?"

If YES, please describe the circumstances

Answer required for "If YES, please describe the circumstances"

If YES, was student diagnosed with a concussion?

Answer required for "If YES, was student diagnosed with a concussion?"

Yes

I, the undersigned parent or legal guardian of the student named below, hereby give permission for my child to participate in school-sponsored athletic activities. I understand that participation in sports involves inherent risks of injury, including serious bodily harm. I acknowledge and accept these risks and agree that the school, its employees, agents, and representatives shall not be held liable for any injuries, accidents, or damages that may occur during my child’s participation, except in cases of gross negligence or willful misconduct. I certify that my child is physically able and permitted to participate in the sport.*

Signature Required

South Shore
Christian AcademyFor Christ. For Others.

Please fix the highlighted areas below before submitting.

2025-2026 Athlete Information Form