Game Day Ready Registration
*Please take the time, read through the questions, and answer to the best of your knowledge*
* = Required Information
*
Have you ever participated in Game Day Ready before?
Required
Yes
No
If Yes, what years?
*
Have you ever participated in organized football wearing a helmet, such as Pop Warner?
Required
Yes
No
At what age did you begin?
Personal Emergency Contact Information
Student ID:
*
School Attending Next Year:
'Select One'
Berryhill MS
Community House
Northeast MS
McClintock MS
James Martin MS
Ranson MS
Albemarle HS
Anson HS
Northwest Cabarrus HS
Wilson Stem Academy
Required
*
Grade Entering:
'Select One'
6th
7th
8th
9th
10th
11th
12th
Required
*
First Name:
Required
Middle Initial:
*
Last Name:
Required
*
Street Address:
Required
Apt/Unit:
*
City:
Required
*
State:
Required
*
Zip:
Required
*
Phone#:
Required
*
DOB:
DOB mm/dd/yyyy
Race:
'Select One'
American Indian or Alaska Native
Asian
Black or African American
Hispanic or Latino
Native Hawaiian or Other Pacific Islander
White
Two or More Races (not Hispanic or Latino)
*
Age:
Required
*
Gender:
'Select One'
Male
Female
Required
Email:
Parent/Guardian Information
*
Parent(s)/ Legal Guardian(s) Residing With:
Required
*
Who Has Custody:
Required
*
Fathers Name:
Required
*
Alternate Phone (Work/Cell):
Required
*
Mothers Name:
Required
*
Alternate Phone (Work/Cell):
Required
Family Physician/Pediatrician:
Physician Phone:
*
Preferred Hospital:
'Select One'
CHS Lincoln
CHS Main
CHS Mercy
CHS Northeast
CHS Pineville
CHS Stanly
CHS University
CHS Union
Presbyterian
Presbyterian Matthews
Presbyterian Huntersville
Other
*
*
Permission To Transport To Hospital:
'Select One'
Yes
No
*
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