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2022-23 Athletic Physical and Authorization Form


2022-23 Athletic Physical Form (to take to the doctor)

If you have any questions about athletic forms, please contact the Athletics Coordinator Kristy Burton at kristy.burton@charchrist.com.

Please select all the sports your child will be participating in this school year.

All students participating in athletics at Charlotte Christian School must have active health care coverage. Please provide the policy number and insurance carrier name:

Please be sure that ALL 4 PAGES of the athletic physical have been completed and signed. You may upload ALL 4 PAGES as one scanned file or you may take a picture of each page individually and upload 4 separate files.

Be sure to upload ALL 4 PAGES.​
Max file size: 10 MBYou may take a picture of the document or scan the document to upload.​​​
Max file size: 10 MBYou may take a picture of the document or scan the document to upload.​​​​
Max file size: 10 MBYou may take a picture of the document or scan the document to upload.​​​​
Max file size: 10 MBYou may take a picture of the document or scan the document to upload.​​​​

Please click on each document below to review the information. Then sign below to consent to the releases and statements.

This is an optional consent.​
Digital Signature Acknowledgement - Type the name of the student in the box below.
Electronic Signature (eSignature): You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action while using any electronic form we offer; or in accessing or making any transactions regarding any document, agreement, acknowledgement, consent, term, disclosure, or condition constitutes your signature, acceptance and agreement as if actually signed by you in writing. Further, you agree that no certification authority or other third party verification is necessary to validate your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or resulting contract between you and Charlotte Christian School. You understand and agree that your eSignature executed in conjunction with the electronic submission of your form will be legally binding and such transaction will be considered authorized by you.
Digital Signature Acknowledgement - Type the name of the parent in the box below.
Electronic Signature (eSignature): You consent and agree that your use of a key pad, mouse or other device to select an item, button, icon or similar act/action while using any electronic form we offer; or in accessing or making any transactions regarding any document, agreement, acknowledgement, consent, term, disclosure, or condition constitutes your signature, acceptance and agreement as if actually signed by you in writing. Further, you agree that no certification authority or other third party verification is necessary to validate your electronic signature; and that the lack of such certification or third party verification will not in any way affect the enforceability of your signature or resulting contract between you and Charlotte Christian School. You understand and agree that your eSignature executed in conjunction with the electronic submission of your form will be legally binding and such transaction will be considered authorized by you.