Health History

If no conditions exist enter NONE. Please list and describe all physical or emotional limitation(s) your child may have, including but not limited to: Allergies, Vision, Asthma, Heart Murmur, High Blood Pressure, etc.

Health Insurance Information

By checking this box, you confirm that the participant listed on this registration form is covered by health Insurance and that the health information provided on this registration form is accurate.

Health Insurance Carrier

Health Insurance Policy Number

AAU Membership

Parent Waiver and Electronic Consent Agreement

By checking this box you confirm that you have read and agree to all terms in the above SDUHSD/TPHSF HOLD HARMLESS, RELEASE OF LIABILITY AGREEMENT FOR EXTRA CURRICULAR ACTIVITIES AND THE PARENT RELEASE AND CONSENT WAIVER.

By checking this box, you agree to the use of your ELECTRONIC CONSENT in lieu of an original signature on paper. You have the right to request to sign a paper copy instead. By checking here, you are waiving that right. After consent, you may, upon written request to us, obtain a paper copy of an electronic record. No fee will be charged and no special hardware or software is required to view it. Make sure that we have your current email address. I agree via electronic consent to the terms above.

Parent Contact Information

Parent First Name

Parent Last Name

Address 1

Address 2

City

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Postal Code

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Mobile Number

Email Address

Yes, I would like to receive email communications.Yes, I would like to receive email communications.