NAPERVILLE NORTH HIGH SCHOOL ATHLETIC INFORMATION/RELEASE FORM
SPORT						SCHOOL YEAR (circle one)
						FR	SO	JR	SR
PLAYER NAME						SCHOOL ID # (required)
STREET ADDRESS
CITY					ZIP		HOME PHONE
MOTHER'S NAME					FATHER'S NAME
MOTHER'S ADDRESS (only if different then player)					FATHER'S ADDRESS (only if different then player)
DO BOTH PARENTS LIVE IN DISTRICT 203?					SCHOOL ATTENDED LAST YEAR
	YES		NO
PLEASE LIST ANY MEDICAL CONDITIONS OR CONCERNS
WE SHOULD BE AWARE OF:
EMERGENCY CONTACT NAME					EMERGENCY PHONE NUMBER
INSURANCE INFORMATION				MY SON/DAUGHTER IS COVERED BY THE FOLLOWING INSURANCE:
Naperville Community Unit School District 203 maintains student school time insurance that includes any school sponsored and/or supervised activity, including athletics (including football). If students have other insurance coverage, District insurance is secondary. The program administrators are Zevitz-Redfield & Associates, Inc. Claim forms are available in each school building.				FAMILY				SCHOOL
				FAMILY INSURANCE PROVIDER
				School District #203 does not assume financial responsibility for accidents  incurred in athletics.  Parents/guardians must give consent for their son/daughter's participation in the athletic program.
I HEREBY GIVE MY SON/DAUGHTER MY CONSENT TO PARTICIPATE IN:
SPORT					PARENT'S SIGNATURE
EMERGENCY MEDICAL INFORMATION
If I can not be reached, and if in the judgment of school authorities immediate medical attention is indicated, authorize responsible school personnel to send my son/daughter to an available doctor or hospital.
DOCTOR PREFERENCE					HOSPITAL
It is my understanding that an current physical MUST be on file with the Athletic Office.
By affixing my signature to this form, I do affirm that I have read and reviewed the Revised Co-Curricular Participation Code in its entirety and understand all the rules governing participation at NAPERVILLE North High School.
PARENT'S SIGNATURE					STUDENT'S SIGNATURE
						FOR NNHS ATHLETIC DEPARTMENT USE