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Release Form

Student Name (First & Last)*

Answer required for "Student Name (First & Last)"

DOB*

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Student Email*

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Parent/Legal Guardian Name*

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Parent/Legal Guardian Phone Number*

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Parent/Legal Guardian Email*

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Address

Street Address*

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City*

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Zip/Postal*

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Do you have any allergies? If Yes, please list:*

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Are you currently being treated for any injuries? Yes or No, if yes please list*

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APPLICATION RELEASE

I, the undersigned, fully understand and agree to all rules and regulations which govern the St. Anthony Catholic High School. I understand and agree to abide by all the rules outlined by St. Anthony Catholic High School Student Code of Conduct.

Date*

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Signature of Applicant*

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PARENTAL RELEASE

II, the undersigned, fully understand and agree to all the rules and regulations which will govern my son/daughter 1to represent St. Anthony Catholic High School as participant in Powder Puff. I further understand that this is an extracurricular activity. I hereby give consent to my son/daughter to participate in Powder Puff at St. Anthony Catholic High School and recognize his/her responsibilities and requirements as a leader of his/her school. Further, I understand that my personal insurance must cover my son/daughter. I give permission for my child to receive medical attention in the event that I cannot be present or reached for any reason.

Date*

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Signature of Parent/Legal Guardian*

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Confirmation Email

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