Boys &amp; Girls Basketball

Boys/Girls Basketball Registration

St. Rita Sports Committee is constantly looking for dedicated volunteers to help support our athletes. Would you like to learn more about joining the St. Rita Sports Committee? REQUIRED Yes. Please contact me about becoming a member of the St. Rita Sports Committee. Not at this time. Please fill out this field.

PARENTS' INFORMATION

I am the child's: REQUIRED Please fill out this field.

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

City REQUIRED Please fill out this field. Please enter valid data.

State REQUIRED Please fill out this field.

Zip REQUIRED Please fill out this field. Please enter a zip code.

Phone Number REQUIRED

Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

My Child Has the Following Health Insurance Coverage: Private Health Insurance All School Insurance Through St. Rita

The Name of My Private Health Insurance Company and Policy Number is:

Please identify the name and policy number of your insurer.

Please enter valid data.

Policy Holder's Name REQUIRED Please fill out this field. Please enter valid data.

STUDENT'S INFORMATION

Name of Student/Athlete:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Current Grade REQUIRED 5th Grade 6th Grade 7th Grade 8th Grade Please fill out this field.

Gender REQUIRED Male Female Please fill out this field.

Has your child completed and turned in a sports physical within the last 12 months?

Each child must have completed a sports physical within the past 12 months to participate in athletics at St. Rita. Please confirm whether your child has done so AND turned in a copy of the sports physical to St. Rita.

Yes No

Please list any and all medical information/conditions. (If none please state n/a.) REQUIRED Please fill out this field. Please enter valid data.

Name of Student's Pediatrician. (If none, state none). REQUIRED Please fill out this field. Please enter valid data.

Pediatrician's Phone Number REQUIRED

Please fill out this field. Please enter a phone number.

EMERGENCY INFORMATION AND PERMISSION TO TREAT

Emergency Contact:

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED

Please fill out this field. Please enter a phone number.

Relationship to your child REQUIRED Please fill out this field. Please enter valid data.

Permission to Treat

During athletic competition, there are situations that sometimes arise where a student/athlete may require emergency medical attention.

In the event we cannot be reached to obtain permission for medical attention, by clicking "I Agree" below, I hereby authorize St. Rita school, youth programvolunteers, and/or its authorized agent and employee representative(s) to act for me in an emergency or other circumstance requiring any medical treatment or attention on behalf of my child without any further permission. This consent and authorization shall include, but not be limited to, obtaining necessary hospital, medical, surgical, dental, optical, pharmaceutical, and any related care for my child and to sign any authorization therefore including admissions and/or discharges from any hospital or other care facility. I also agree to assume financial responsibility for all costs associated with medical treatment and/or transportation.

St. Rita staff will make every effort to reach the provided emergency contacts in the event of a medical issue. In most cases, parental permission will be obtained before providing treatment, especially in nonemergency situations.

I Agree Please select this field.

St. Rita athletics are run almost exclusively by volunteer parent coaches. Coaching is extremely rewarding and we are always in need of qualified coaches. Would you be willing to help coach your child's team this year? Yes! I'd love to! Sorry, but not at this time.

Please contact me at the number below to discuss the possibility of coaching in further detail.

Saint Rita of Cascia School

"Rejoice always, pray continually, give thanks in all circumstances;
for this is God's will for you in Christ Jesus." -1 Thessalonians 5:16-18

Boys & Girls Basketball