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PHA Athletic Registration Form 22-23
22-23 PHA Athletics Registration
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* Indicates required question
Email
*
Your email
Student Athlete Name
*
Your answer
Parent/Guardian Name
*
Your answer
Parent/Guardian Email Address
*
Your answer
Parent/Guardian Phone Number
*
Your answer
Date of Last Physical (Electronic or Hard Copy must be given to the nurse from within the past 13 months)
*
Your answer
Grade Level
*
7th Grade
8th Grade
9th Grade
10th Grade
11th Grade
12th Grade
Other:
Fall Activity Selection
Cross Country
Girls Volleyball
Boys Soccer
Girls Soccer
Clear selection
Winter Activity Selection
Boys Basketball
Girls Basketball
Cheerleading
Clear selection
Spring Activity Selection
Track
Softball
Baseball
Boys Volleyball
Clear selection
My family and I understand and agree to the terms and conditions of the PHA Athletic Handbook
*
Yes
No
My family and I consent to the use of photographs/videos of my child while participating in PHA sponsored athletic events on the school's social media accounts
*
Yes
No
My Family and I have completed and understand the NFHS Concussion Course (
https://nfhslearn.com/courses/concussion-in-sports-2
)
*
Yes
No
Parent/Guardian Name For Electronic Signature
*
Your answer
Submit
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