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Athletics Registration Form

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  Pay to Play Fee - $75
  
  A fee reduction or full fee waiver
  may be available on an as needed basis.
  
  Please contact our Athletic Director for more information.
  
  Sport REQUIRED Please fill out this field.
  
  Student Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field.
  
  Team REQUIRED Girls' Team Boys' Team Please fill out this field.
  
  Parent/Guardian Name REQUIRED Please fill out this field. Please enter valid data.
  
  Email REQUIRED Please fill out this field. Please enter an email address.
  
  Home Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Mobile Phone Number Maximum 20 characters Please enter a phone number.
  
  Insurance Provider REQUIRED Please fill out this field. Please enter valid data.
  
  Primary Doctor's Name REQUIRED Please fill out this field. Please enter valid data.
  
  Hospital Preference REQUIRED Please fill out this field. Please enter valid data.
  
  Allergies/Medication REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Name REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Relationship REQUIRED Please fill out this field. Please enter valid data.
  
  Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter valid data.
  
  I give my child permission to participate in SMC/St. Brigid for the 2021-2022 season.
  
  I Agree Please select this field.
  
  Any questions? Contact Julie Roy, Athletic Director.
  
  Submit
  
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- Contact Us
  
  Julie Roy
  
  Athletic and Aftercare Director
  
  julie.royportlanddiocese.org