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Get Physician And Parental Permission, KHSAA Form GE04, Rev. 4/13 ... - Fcps

And Student Consent and Release Lexington, Kentucky 40505 For High School Level (grades 9-12) participation PART I - ATHLETE INFORMATION (This part must be completed by the student) Name (Last, First, Initial) School Year Home Address (Street, City, State, Zip): Gender Grade School Date of Birth: Birth Place (County, State): Attendance History Grade School Name School Year Varsity Play (Yes/No)? 9 10 11 12 I am planning to participate in the following (check all you might try to play): Base.

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