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ATHLETE/PARTICIPANT INFORMATION
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Last Name
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First Name
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Middle Name
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Gender
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Date of Birth (mm/dd/yyyy)
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Address
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Zip-Code
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Father's Name
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Mother's Name
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Student ID
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Phone Number
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E-Mail
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State or Country of Birth
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Year Entered 9th grade
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School Attended Last Year
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ANTICIPATED ATHLETIC PARTICIPATION
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Fall Sports :
Football
CrossCountry
Soccer
Volleyball
Golf
None
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Winter Sports :
Basketball
Swimming & Diving
Wrestling
None
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Spring Sports :
Baseball
Softball
Tennis
Track & Field
Golf
None
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Year-Round Sports :
Cheerleading
Dance
MCJROTC
None
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RESIDENCE INFORMATION
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1 :
I presently live in the La Cueva Attendance area with a parent and/or guardian
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If so, with whom do you live?
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2 :
I do not live in the La Cueva Attendance area. I am on an approved APS transfer to attend La Cueva
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If so, from what High School
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3 :
I will be (or am) taking classes at a site other than La Cueva
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List (UNM, CNM, Charter School, Ideal-NM, or Other) :
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DISCLOSURE STATEMENT - WARNING OF INHERENT RISK
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(Must me read and agreed to by parents and students)
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I agree that all the information provided on this form is true and accurate. If an information on this form
changes, I realize that it is my responsibility to inform La Cueva High School, my coach or sponsor, and the
Athletic Director immediately!
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We (as parent and athlete) acknowledge the risks inherent int he sport and understand the full range of injuries
from minor to severe.
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We (as parent and athlete) understand the catastrophic nature of athletic injury. We recognize that an athlete
might die, become paralyzed, or suffer brain damage or other serious, permanent injuries as a result of
participation in this sport.
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We also understand that it is our responsibility to make the coach and athletic trainer aware of any injuries incurred
during the season and follow all prescribed treatments whether by the trainer or a physician. It is also our responsibility to
inform the coach or trainer any time I visit a physician for any athletic injury and for a disease which may have an effect on
my ability to participate or interact with team members.
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We are aware that we are responsible for providing personal safety equipment, maintaining personal and school distributed
equipment, and attending practices and meetings where safety and risk are addressed.
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ACKNOWLEDGEMENT
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Signature
I have read the information on this form and I understand and acknowledge the inherent risk in sport and
agree to accept and participate under established guidelines
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(Parent/Guardian) Signed By
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END OF FORM
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