Athletics Outside Sport Authorization Form Providence Country Day School

*Student First Name

*Student Last Name

*Season

Fall

Winter

Spring

*Grad Year

*Sport

*Organization Name

*Organization Address

Organization Address 2

*City

*State

*ZIP Code

*Coach/Instructor Contact Name

*Coach Email

*Coach Phone Number

*Sport Details (Please specify days of the week, hours committed per day/week/month, etc.)

*Description of Daily Activities and Expectations

Authorization: I affirm that by checking this box I authorize my child to participate in the outside sport specified above

*Parent/Guardian Name

*Date

Athletics Outside Sport Authorization Form