Permission Form for Athletic Participation
We grant our child permission to participate in Unified Sports for the school year 22-23. We agree to abide by the athletic regulations of the school. We further understand that participating in a sport may result in injury  to the participant and that our child cannot participate in the above activity until they  have provided proof of a physical examination by a physician within the past year. The following information must be provided before the student can participate.

The school does not provide insurance coverage for the student athletics. If you have purchased  insurance coverage through the school (either 24 hour or “school time”) those policies cover  athletics.
If your child is injured, no matter how slight, they should report it to their coach so that the proper forms can be initiated. If they are taken ill by an athletic related injury after leaving practice or a game and must be taken for medical assistance, they should report this fact to the coach immediately upon returning to school.

Sign in to Google to save your progress. Learn more
Email *
Student Last Name *
Student First Name *
Grade *
Date of Birth *
MM
/
DD
/
YYYY
Do you subscribe to a prepaid hospital and/or medical care plan or insurance such as Blue  Cross/Blue Shield? *
Name of Plan *
ID # for the Insurance Plan *
Street Address *
Emergency Phone Number *
Parent Email *
Next
Clear form
Never submit passwords through Google Forms.
This form was created inside of Dighton-Rehoboth Regional School District. Report Abuse