Athletics Medical Insurance Information and Certification

Please complete the form below. Mandatory fields marked *

California Law requires: That every member of an athletic team must have accidental bodily injury insurance providing at least $1,500 of scheduled medical and hospital benefits.

By completing this form online, I hereby certify that we carry insurance protection that fulfills state requirements.

Insurance Information
Parent/Guardian Signature
By typing my name below I certify that all the information on this form is accurate and complete and I consent to have the above named student participate in athletics.