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Invitation for Clearance Through Healthy Roster
***Please Enter The Correct Parent/Guardian/Emergency Contact Email (Make sure it is correct - The Invitation will be sent to this email)***
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* Indicates required question
Student-Athlete School ID #
Your answer
Student-Athlete FIRST NAME
*
Your answer
Student-Athlete LAST NAME
*
Your answer
Student-Athlete Date of Birth *
*
MM
/
DD
/
YYYY
Gender
*
Male
Female
Prefer not to say
Student-Athlete Graduation Year
*
Choose
2022 - Senior
2023 - Junior
2024 - Sophomore
2025 - Freshman
Student-Athlete EMAIL (mylcusd email will not work)
*
Your answer
Student-Athlete HOME PHONE NUMBER
Your answer
Student-Athlete CELL PHONE NUMBER
Your answer
Parent/Guardian/Emergency Contact FIRST NAME #1
*
Your answer
Parent/Guardian/Emergency Contact LAST NAME #1
*
Your answer
Relationship to Student-Athlete
Your answer
Parent/Guardian/Emergency Contact EMAIL #1
*
***PLEASE MAKE SURE THIS EMAIL IS CORRECT - THE INVITATION WILL BE SENT TO THIS EMAIL***
If using Hotmail.com check spam folder
Your answer
Parent/Guardian/Emergency WORK PHONE NUMBER #1
Your answer
Parent/Guardian/Emergency CELL PHONE NUMBER #1
*
Your answer
Parent/Guardian/Emergency Contact FIRST NAME #2
Your answer
Parent/Guardian/Emergency Contact LAST NAME #2
Your answer
Parent/Guardian/Emergency Contact EMAIL #2
Your answer
Parent/Guardian/Emergency WORK PHONE NUMBER #2
Your answer
Parent/Guardian/Emergency Contact CELL PHONE NUMBER #2
Your answer
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