IEA Sports Registration

Parent/Guardian Information
Parent/Guardian Name

First NameLast Name
Parent/Guardian Email
example@example.com
Parent/Guardian Phone
Please enter a valid phone number.Format: (000) 000-0000.
Participant Information
Child's Name

First NameLast Name
Grade Level
Teacher Name
Select the sport your child is registering for:
Code of Conduct Acknowledgment

Please review the details below carefully with your child participant. Each statement must show your agreement to adhere to these standards and expectations.
Student-athletes represent IEA and the Firebirds name at all times — in practice, at games, while traveling with the team, and on social media. As a student-athlete and family, you agree to:
Acknowledgement and Signature

My child and I have read, understand, and agree to all expectations outline in the Code of Conduct. Consequences for violations are determined by the Athletic Director and Executive Director and may include a warning, benching, suspension, or removal from the team, consistent with IEA's Discipline Policy.
Parent/Guardian Signature
Date

MonthDayYear
2 digit month, 2 digit day, 4 digit yearDate
Concussion & Head Injury Policy Acknowledgment

A concussion can occur even without loss of consciousness, and even from a hit that looks mild. Continuing to play after a concussion, or returning too soon, significantly increases the risk of serious or lasting injury. IEA does not provide student athletic accident insurance; families are responsible for medical costs related to injury. Consistent with Utah's Protection of Athletes with Head Injuries Act (Utah Code §§26B-4-401 through -405) and USBE Rule R277-614, every family must review this information and sign below before a student's first tryout or practice.
I understand that the signs and symptoms of a concussion are as follows (read and check all):
I understand that IEA will do the following if I am showing signs of a concussion or head injury (read and select all):
Assurances and Signatures
Parent/Guardian Signature
Emergency Contact and Medical Information

Please complete this information fully. This information is kept confidential and shared only with your student's coach, the Athletic Director, and emergency medical personnel if needed.
Primary Emergency Contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child.
Secondary Emergency Contact
Name

First NameLast Name
Phone Number
Please enter a valid phone number.Format: (000) 000-0000.
Relationship to child.
Medical Information
Physician Name and Phone

First NameLast Name
Health Insurance Provider
Allergies
Medications
Medical Conditions
Other Information

Is there anything else you’d like us to know regarding your child’s participation in IEA athletic activities?
Signatures and Fees

Participation Fee Per-sport participation fees are set annually and approved by the IEA Board; Current amounts are published each season by the Director. Fee waivers and payment plans are available — contact the Director, Heidi Long, hlong@igniteutah.org, confidentially if cost is a barrier to participation. Fees are generally non-refundable once a roster is submitted to UCSSAL.
Amount Due

Registration Fee Due Today:

USDDescription

Credit Card

First Name

Last Name

Credit Card Number

Security Code

Expiration Month

Expiration Year

Billing Address

Street Address

Street Address Line 2

City

State / Province

Postal / Zip Code

Country

Acknowledgement

By signing below, I confirm that I have completed all sections of this Athlete Registration Form, that the information provided is accurate, and that I have read and agree to the Code of Conduct and Concussion & Head Injury Policy as a condition of my student's participation in Firebirds Athletics.
Parent Signature
Should be Empty:

Parent/Guardian Information

Participant Information

Code of Conduct Acknowledgment

Acknowledgement and Signature

Concussion & Head Injury Policy Acknowledgment

Emergency Contact and Medical Information

Primary Emergency Contact

Secondary Emergency Contact

Medical Information

Other Information

Signatures and Fees

Registration Fee Due Today:

Acknowledgement