Submission of this form is required for participation in the Fairfield Prep Athletic Program and is to be submitted prior to the start of each sport season. Submission is an acknowledgement that both the student athlete and the parent(s)/legal guardian have read and agree to the terms and conditions listed for participation. You will be prompted with this message at the end of the registration form and both the parent/guardian and the student athlete will be asked to acknowledge.

What is the student's legal last name? required

What is the student's legal first name (no nicknames)required

Student's date of birth (mm/dd/yyyy)required

Student's grade required

Is your son a transfer student?*

No Yes

Name of previous school, town, state. required

I acknowledge that I have read and agree with the terms of the following documents:

I Agree*

Agree

I agree to abide by the Fairfield Prep Chemical Health Policy which is available on the Fairfield Prep web site under Athletics Forms and Documents.

I Agree*

Agree

I acknowledge that I have a Sports Physical on file with the school nurse within the year of when the student-athlete will be participating. This is available on the Fairfield Prep web site under Athletics Forms and Documents.

I Agree*

Agree

I acknowledge that I have read and understood the following documents. I understand the severities associated with concussions and the need for immediate treatment of such injuries.

I Agree*

Agree

Do you have any medical condition(s) that the athletic trainer should be aware of?*

Yes No

Please describe the medical condition(s).required

In case we are unable to reach a parent or guardian, please provide information for an emergency contact.

Emergency Contact Namerequired

Emergency Contact Numberrequired

Submission of this form is required for participation in the Fairfield Prep Athletic Program and is to be submitted prior to the start of each sport season. Submission is an acknowledgement that both the student athlete and the parent(s)/legal guardian have read and agree to the terms and conditions listed for participation.

Parental Acknowledgement*

I Agree

Parental email addressrequired

Parental Phone Numberrequired

Submission of this form is required for participation in the Fairfield Prep Athletic Program and is to be submitted prior to the start of each sport season. Submission is an acknowledgement that both the student athlete and the parent(s)/legal guardian have read and agree to the terms and conditions listed for participation.

Student Acknowledgement *

I Agree