Ultimate Frisbee Registration
Please complete all sections of this registration for ultimate frisbee. Completing this registration will allow the student to participate in the ultimate frisbee club at VCA. If this form is not completed, students will not be able to participate until it is completed.

Contact: Chris Erickson 
Email: cerickson@vcacademy.info
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Student's Name
2023-2024 Grade
Birthdate
MM
/
DD
/
YYYY
Home Address
Parent's Name
Parent's Email
Parent's Cell Phone Number
Second Parent's Name
Second Parent's Email
Second Parent's Cell Phone Number
Emergency Contact #1- Name
Emergency Contact #1- Cell Phone
Emergency Contact #2- Name
Emergency Contact #2- Cell Phone
Physician- Name
Physician- Phone Number
Insurance Provider
Insurance Policy Number
Medications- Please List All
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