Diocesan Health Form

Your child’s safety is of utmost importance.  This form allows us to have critical information with the coaches in case medical attention is needed during practices or games.  

Every child is required to have a current (based on school year) Diocesan Health Form completed and turned in to the Athletic Director at Saint Rose before the child can participate in a sport (practice and games).  Once a form is submitted, we will use it for any new sport your child plays later in the school year.  We recommend you complete the form as early as possible.  Please understand that a doctor’s signature is required and could take a few days to complete this step.


Below is a link to the Diocesan Health Form as an editable PDF.  After opening this file, we recommend you click “File and Save As” to create your own personal document on your computer.  If you plan to scan the completed document after obtaining the necessary signatures, please include your child’s name in the naming of the document.  This helps when receiving the file electronically.


The pastor or designee signature for the Eligibility for Religious Education Students section is not needed before submitting the form.  The Athletic Director will obtain this signature.

When filling out the form, simply click on the light blue boxes on the blank lines to type in the necessary information.  None of the signature lines have the editable blue boxes.  Therefore, they will require a written signature.  If you prefer to fill out the form by hand, you can simply print the form.  Please print double sided to save paper.

Once the form is completed, you can drop it off at the school or church office to the attention of the Athletic Director.  You can also email it to athletics@saintrose.org.