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

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Sunday Masses:
Saturday 4pm; Sunday: 7:30am, 9:00am, 10:30am, 2pm (Traditional Latin Mass)

Daily Masses:
Monday-Friday 6:30am
Tuesday/Thursday 8am (school days 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