24/25 Mile High Mountain Bike Registration Form
Please complete the following questions to register your child.
Sign in to Google to save your progress. Learn more
Student's Last Name *
Student's First Name *
Name of parent/guardian completing this form *
Relationship to child *
Grade level of student *
This student attends *
Permission and Consent
I hereby give my consent for the above named student to engage in the events of the school in the sports listed above and accompany the group as a member of that sport’s out-of-town trips. If emergency service involving medical action or treatment is required and neither parent or guardian can be contacted I hereby consent for the student named above to be given medical care by the doctor selected by the school and/or coach.  I, the parent or guardian of the student, do hereby give and grant unto any medical doctor or hospital, my consent and authorization to render such aid, treatment or care required, on an emergency basis, in the event said student should be injured or stricken ill while participating in an activity sponsored or sanctioned by Prescott Mile High Middle School.  I understand that all concussions are considered serious. If the coach and or official has deemed a player removed for a concussion, then reinstatement will require a doctor's notice. It is hereby understood that the consent and authorization hereby given and granted are continuing and are intended by me to extend throughout the current school year.   *
I give my consent for the above named student to be photographed by school personnel during athletic events and team photos and for these images to be displayed in the school yearbook, school website, and/or campus display boards.  
 *
Contact information
Best phone number(s) to reach a parent/guardian
Email Address
Email Address
Medical Insurance
Medical insurance is required for the student to participate. If the student is currently uninsured, there are low cost, school insurance policies available (see School website for more details).
Name of Insurance Company *
Insurance Policy # *
Any medical issues we should be aware of?
Pay to Play Fee
The Pay to Play fee at Mile High is $110.  For students who are eligible and signed up for the Free and Reduced Lunch program, the Pay to Play fee is $55.00. We can accept checks made out to PMHMS or cash at the Mile High front office. You can also pay online using the PUSD website and get a tax credit receipt. Please select one of the options below. *
Student-Athlete Expectations
Should be completed with student.
As a participant in the Prescott Mile High Middle School Athletic program, students agree to follow the rules and expectations set forth by the coach of the sport listed above. The student understands that if the rules and expectations set forth by the coach are violated, the students participation on the team may be limited or may result in removal from the team entirely.   *
The student will maintain positive behavior and passing grades in all classes.  There will be regular grade checks and students can be ineligible to play if they are receiving failing grades.  See our No Pass, No Play policy on our website for more details.  Also, if students violate the behavior expectations of the classroom or school, there may be consequences resulting in reduced participation on the team, or removal from the team. *
Are there any other issues that you would like the coaches to be made aware of?
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Prescott Unified School District. Report Abuse
Google Forms