FORMS
WAUKESHA KNIGHTS
PLAYER INFORMATION
Name: ______________________________ Age: ________ D.O.B: __________
Parent/ s Name: ___________________________________________________
Address: _________________________________________________________
City: _______________________ Zip Code: _____________________________
Home Phone #: ____________________
Mother’s E-mail Address: ______________________________________________
Mother’s Cell Phone #:________________________________________________
Father’s E-mail Address: _______________________________________________
Father’s Cell Phone #: _________________________________________________
Attending School: _______________________________ Grade: _____________
Player lives with: ( ) Both Parents ( ) Mother ( ) Father ( ) Legal Guardian
Emergency Contact:
Name: ______________________________ Address: ______________________
Work Phone #: ____________ Home Phone #: _______________Cell Phone #:_____________
Relationship to Player: _________________________________
Physician and Insurance information:
Family Doctor: ______________________________ Phone #: __________________________
Address: ______________________________________________________________________
Insurance Provider: _____________________________________________________________
Policy #: ______________________________________________________________________
Policy Owner: __________________________________________________________________
Group #: ______________________________________________________________________
Medical Information
Please indicate if your child has any health problems, takes any medication or is allergic to any medicine or food? : _____________________________________________________________
______________________________________________________________________________
Parent Signature: ________________________________ Date: ___________