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Unified Sports Intent To Enter Form
High School/Middle School

Team Name:
School:
Telephone:
Address:
City/Town:
Zip Code:
Event you wish to enter (submit a separate entry for each):
Number of Wheelchairs:
Roster:
Name Date of Birth M/F Athlete/
Partner
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Name of Principal:
Name of Coach:
Coach's Direct/Cell Telephone:
Coach's e-mail:
Practice Schedule:
CERTIFICATION
By checking this box the listed coach certifies that the students listed in the above form have satisfied
the State Health Statutes and local regulations regarding physical examinations and are physically fit to participate.