Blessed Sacrament School

Springfield, IL

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Cheerleading

- Permission Form
  
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  Student First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Student Last Name REQUIRED Please fill out this field. Please enter valid data.
  
  Grade REQUIRED Please fill out this field. Please enter valid data.
  
  Chid's Birth Date REQUIRED Please fill out this field. Please enter a date.
  
  Parents REQUIRED Please fill out this field. Please enter valid data.
  
  Additional Parent (if necessary) Please enter valid data.
  
  Family Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Parent Email Address REQUIRED Please fill out this field. Please enter valid data.
  
  Additional Parent Email (if desired) Please enter valid data.
  
  Emergency Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Friend or relative if you can't be reached Please enter valid data.
  
  Friend/Relative Phone Number REQUIRED Maximum 20 characters Please fill out this field. Please enter a phone number.
  
  Name of Insurance Carrier REQUIRED Please fill out this field. Please enter valid data.
  
  Insurance Policy # REQUIRED Please fill out this field. Please enter valid data.
  
  Name of Primary Doctor REQUIRED Please fill out this field. Please enter valid data.
  
  Preferred Hospital REQUIRED Please fill out this field. Please enter valid data.
  
  Special Health Concerns:
  
  My child must have had a physical examination within the past 12 months, and a concussion form signed and on file in the school office.
  I Agree Please select this field.
  
  Health insurance is my responsibility. Students must have insurance in order to play on a school team.
  I Agree Please select this field.
  
  Blessed Sacrament School is NOT liable for injuries incurred this season.
  
  Current Physical
  Office Use only
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  Concussion Form
  Office Use only
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  Please pay your registration fee online through the link to the right.
  
  Payment
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