Current Athlete Registration Form

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Warning of Risk & Declaration of Release *

Emergency Contact Information

Personal Medical History

Please check any of the following that apply to you: *
Please select any of the following medical conditions that are in your family: *
Have you ever had a concussion? *
Has a physician cleared you to play since your last concussion?
Have you ever had any of the following? *
Have you had any problems with any of the following? *
* required field