JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
HP Intramural Sports - Emergency Form
Sign in to Google
to save your progress.
Learn more
* Indicates required question
Student First Name
*
Your answer
Student Last Name
*
Your answer
Student ID
*
Your answer
Grade
*
6th
7th
8th
Sport(s)
Basketball
Badminton
Ultimate Frisbee
Parent First Name
*
Your answer
Parent Last Name
*
Your answer
Parent Email
*
Your answer
Parent Phone Number
*
Your answer
Other Phone Number (optional)
Your answer
Other Phone Number (optional)
Your answer
Emergency Contact (beside parent listed above) - First Name
*
Your answer
Emergency Contact (beside parent listed above) - Last Name
*
Your answer
Emergency Contact (beside parent listed above) - Phone Number
*
Your answer
Name of Medical Insurance
*
Your answer
Medical Number
Your answer
Digital signature for consent to participate- Please type your name below.
*
Your answer
Digital signature for consent to participate- Please enter the date below.
*
Your answer
Submit
Clear form
Never submit passwords through Google Forms.
This form was created inside of Pleasanton Unified School District.
Report Abuse
Forms
