Athlete Registration

Athlete Registration
2021-22

* Indicates required field

Student Name *

First

Last

Date of Birth *

Gender: *

Grade Level for 2021-22 School Year: *

School Attending: *

Primary Parent/Guardian Email: *

Secondary Email: *

Note: Primary Parent/Guardian email will be the used for ALL Athletics communication.

My child wishes to play:

My child has previously played:

Basketball? *

Yes No

Basketball *

Yes

Volleyball? *

Yes No

Volleyball *

Yes

Track? *

Yes No

Track *

Yes

Parent/Guardian Information:

Parent/Guardian 1 Name: *

First

Last

Street Address: *

Primary Phone Number *

City: *

Secondary Phone Number *

Parent/Guardian 2 Name: *

First

Last

Street Address (if different than above) *

City: *

Primary Phone Number *

Secondary Phone Number *

Emergency Contact Information

Name *

First

Last

Relationship: *

Other Emergency Contact Phone Number *

Medical Information

Family Physician *

Physician Phone Number *

Hospital of Preference *

Physical Examination Form:

All students participating in interscholastic athletics must have this form on file at their school/parish prior to practice or participation. A physical examination taken April 1 and thereafter is approved for the following two years of competition; physical examination taken before April 1 is valid only for the remainder of the current school year and the following year.

Choose One *

Physical Exam Submitted Last Year I will download, complete, and submit the Physical Examination Form.

Insurance Information

Name of Family Member Holding Insurance (Subscriber) *

Member or Group # *

Policy # *

Insurance Company Name *

Continue to Authorization for Emergency Medical Treatment

Our Ministries

For Kids
For Teens
For Adults
For Seniors
For Visitors

Our School

Learn With Us
About our School
For Parents
For Students
Our School Staff
School Calendar
Support our School
After School Care
Athletics

Join us at Mass

Sunday Masses (Phase 2):
Saturday 4pm; Sunday: 7:30am, 8:45am, 10am, 11:15am, 2pm (Traditional Latin Mass)

Daily Masses (Phase 2):
Monday-Friday 6:30am
Tuesday/Thursday 8am (school children only)
Saturdays 8am

Sacrament of Reconciliation

St. Mary's Visitation Catholic Parish, 1260 Church Street, Elm Grove, WI 53122 | 262-782-4575
Parish Office Hours: Mon/Wed 8:30am-3:30pm | Tues/Thurs/Fri 8:30-noon

St. Mary's Visitation Catholic School, 13000 Juneau Boulevard, Elm Grove, WI 53122 | 262-782-7057