FLEETWOOD PARK SECONDARY SCHOOL
7940 – 156 Street, Surrey, British Columbia V3S 3R3 Ph: 604-597-2301 Fax: 604-597-6481 www.sd36.bc.ca/fltsec
Medical and Student Information
First Name:
Last Name:
Grade:
8
9
10
11
12
Medical Concerns/Allergies & Treatments:
Care Card Number:
Parent/Guardian Name(s):
Home Phone Number:
Work Phone Number:
Cell Phone Number:
Emergency Contact other than
Parents/Guardians (Name):
Emergency Contact Phone Number:
T-Shirt Size:
Small
Medium Large
Extra-Large
Student Athlete’s Email:
Student Athlete’s Phone Number:
By signing below, you acknowledge that both the athlete and their parent/guardian have read and
agree to the Student-Athlete Code of Conduct that can be found on Fleetwood Park’s Athletic
website.
_______________________________
Parent Signature
________________________________
Date