Registration | Leonia Athletics

Username*

Name- Parent/Guardian/Caretaker*

First Last

Email- Parent/Guardian/Caretaker*

Password*

Enter Password Confirm Password

How many children do you have?*

CHILD INFORMATION

School (for 2024-2025 school year)*

Student Name*

First Last

Gender*

Student Email*

Age*

Date of Birth*

Home Phone 1*

Date Entered Leonia HS*

Have you ever attended another High School?*

Which High School?*

CHILD 2 INFORMATION

School (for 2024-2025 school year)*

Student Name*

First Last

Gender*

Student Email*

Age*

Date of Birth*

Home Phone 2*

Date Entered Leonia HS*

Have you ever attended another High School?*

Which High School?*

CHILD 3 INFORMATION

School (for 2024-2025 school year)*

Student Name*

First Last

Gender*

Student Email*

Age*

Date of Birth*

Home Phone 3*

Date Entered Leonia HS*

Have you ever attended another High School?*

Which High School?*

ADDRESS

Address*

Street Address City State ZIP Code

PARENT/GUARDIAN/EMERGENCY CONTACT INFORMATION

Parent-Guardian #1*

First Last

Parent Email*

Work Phone*

Cell Phone*

Parent-Guardian #2

First Last

Parent #2 Email

Work Phone

Cell Phone

Alt. Contact #1*

First Last

Relationship*

Work Phone*

Alt. Contact #2

First Last

Relationship

Work Phone

PHYSICIAN/MEDICAL INFORMATION

Physician Name*

First Last

Phone*

Fax

Address*

Street Address City State ZIP Code

Dentist Name

First Last

Phone

Address

Street Address City State ZIP Code