LIL DRAGONS are BACK!!!
Times and dates for all programs may adjust due to weather, availability of facilities, and holiday weekends.
All dates below are tentative and are subject to change.
HOW MUCH WILL IT COST?
Registration Fees are PER sport. This fee must be paid at the time your registration form is submitted to the Athletics Office. Payments should be made with cash, money order, or certified check.
NO PERSONAL CHECKS ACCEPTED!
If you have any question please contact the Assistant Athletic Director Mike Orr At:
morr@summit-academy.com (734)-955-6061
Summit Academy Athletic Department Registration and Medical Information Form
Select Sport: Dragonites XC____ Football:______ Basketball:________
Soccer: ________Baseball/Softball:_______Volleyball:_______Cheer:__________
Circle Grade: K / 1st / 2nd / 3rd / 4th / 5th / 6th
Circle Shirt Size: YS / YM / YL / AS / AM / AL / AXL
School Attending:
_____Summit Academy North Elementary _____Summit Academy Middle School
Player: __________________________ Birth Date: ____________ M/F Grade: ______
Address: _____________________________ City: _______________ Zip:___________
Parent/Guardian: _____________________________Phone Number: ________________________
Email: ___________________________________________________________________________
Emergency Contact and Phone Number: ________________________________________________
I am interested in volunteering as a coach: YES___ NO___
Player’s Health History:
Has your child had or does your child have any of the following medical difficulties? (If you answer YES to any please describe the problem and its implication for proper first aid treatment.)
Head Injury Y/ N Allergies Y/ N Shoulder Injury Y/ N Fainting Spells Y/ N Hernia Y/ N Knee Injury Y/ N Epilepsy Y/ N Diabetes Y /N Broken Finger Y / N Neck/ Back Inj. Y / N Heart Murmur Y / N Broken Arm Y/ N Kidney Prob. Y / N Poor Vision Y / N Asthma Y / N Poor Hearing Y / N High BP Y / N Neurological Cond. Y / N
I understand that Summit Academy Athletic Department, Schools, and member associates will not be held responsible for any injuries. I accept responsibility for any medical bills incurred, as well as costs for transportation by means of ambulance or motor vehicle to a hospital if necessary. By my/our signature I/we accept all the responsibility while my/our child is participating in practice, games, etc., and traveling to and from such activities.
AUTHORIZATION TO CONSENT TO MEDICAL TREATMENT FOR MINOR CHILD
I/we _________________and _________________ do hereby state that we are the natural parents/legal guardians having legal custody of ____________________________ a minor, age______, born______________. I/we authorize an adult agent of the Summit Academy Athletics/Schools to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis of treatment, and hospital care, to be rendered to the minor under the general or special supervision and on the advice of any physician or surgeon licensed to practice in the state of Michigan, when the need for such treatment is immediate, and when effort to contact me/us are/is unsuccessful.
X______________________________________________________________________________________________________________________SIGNATURE OF PARENT(S) / GUARDIAN(S) DATE