BISHOP O'DOWD HIGH SCHOOL INTERNATIONAL STUDENT ...

BISHOP O’DOWD HIGH SCHOOL INTERNATIONAL STUDENT REGISTRATION
Information Regarding the Student, Family and Host Family/Guardian
All Forms Are Due by July 1, 2010
STUDENT INFORMATION
Expected Grade in Fall 2010: _______________ (9 th , 10 th , 11 th , 12 th )
Student’s Legal First Name:
Student’s Middle Name:
_________________________________
_________________________________
Student’s Family Name/Last Name: _________________________________
Nickname/Preferred Name:
Student Email:
Gender (male/female):
Date of Birth (month/day/year):
City of Birth:
Country of Birth:
Country of Citizenship:
Ethnic Background:
Religion (if any):
Parents’ Primary Language:
_________________________________
_________________________________
_________________
___________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
_________________________________
PARENT/HOME COUNTRY INFORMATION
Parent/Home Country Information
Please enter the information for the Student’s parents below. If the Student in his/her home
country is in the care of a legal guardian rather than parents, please enter the legal guardian
information instead.
Please specify who has legal responsibility

for interacting with the school:
Please specify who has legal responsibility
for interacting with the host family:
Please specify who has legal responsibility
for tuition/school bills:
_______________________________
______________________________
______________________________
Parent 1/Home Country Contact Information:
Relationship to Student:
Title (Mr., Ms., Mrs., Dr., etc.)
Parent 1 First Name:
Parent 1 Family Name:
Company Name (work):
Title/Position:
Business Address:
City:
State:
Country:
Business Phone:
Extension:
Cell Phone:
Preferred Email:
Parent 1 Home Address:
City:
State:
Country:
______________________________
_________
______________________________
______________________________
______________________________
______________________________
______________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
________________________________
_____________________________
_____________________________
_____________________________

Home Phone:
_____________________________
Parent 2/Home Country Contact Information:
Relationship to Student:
Title (Mr., Ms., Mrs., Dr., etc.)
Parent 2 First Name:
Parent 2 Family Name:
Company Name (work):
Title/Position:
Business Address:
City:
State:
Country:
Business Phone:
Extension:
Cell Phone:
Preferred Email:
______________________________
_________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
______________________________
Host Family/US Guardian Contact Information
Please enter the information for the student’s host family/guardian in the vicinity of Oakland,
California, USA, unless the student will be residing in the Oakland area with his/her parent(s).
Please also be sure that the Bishop O’Dowd High School has been provided documentation
for the host family’s guardianship and authority to make school and health care decisions.
Host Family Household Information (Where the Student will be residing):
Host Family Address:
City:
________________________________
________________________________

State: ` ________________________________
Zip Code:
Home Phone Number:
________________________________
________________________________
Host Family/US Guardian 1 Contact Information:
Relationship to Student (if any):
Title (Mr., Ms., Mrs., Dr., etc.)
Guardian 1 First Name:
Guardian 1 Family Name:
Company Name (work):
Title/Position:
Business Address:
City:
State:
Country:
Business Phone:
Extension:
Cell Phone:
Preferred Email:
______________________________
_________
______________________________
______________________________
______________________________
______________________________
______________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
Host Family/US Guardian 2 Contact Information:
Relationship to Student (if any):
Title (Mr., Ms., Mrs., Dr., etc.)
Guardian 2 First Name:
Guardian 2 Family Name:
______________________________
_________
______________________________
______________________________

Company Name (work):
Title/Position:
Business Address:
City:
State:
Country:
Business Phone:
Extension:
Cell Phone:
Preferred Email:
______________________________
______________________________
______________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________
_____________________________

Last Name:____________________
Bishop O'Dowd High School Emergency Health Information
Please Print
Student Name___________________________________ Birth Date__________________
Grade________________________
Home Address_________________________________________ City_______________ Zip________ Phone (___)_____________
Alternate Address_______________________________________ City ______________ Zip ________ Phone (___)_____________
Day
Cell
Name of Father/Guardian________________________________ Phone (____)______________Phone(____)_________________
Day
Cell
Name of Mother/Guardian _______________________________ Phone (____)______________ Phone (___)__________________
Relative, Friend or Neighbor Name __________________ Relationship _______________ Phone (____)________________
Authorized to act on their behalf
if parent/guardian cannot be reached Name __________________ Relationship _______________ Phone (____)________________
CONSENT FOR EMERGENCY TREATMENT
(I, We), the undersigned parent or legal guardian of ____________________________________ a minor, do hereby authorize a representative of Bishop O’Dowd
High School as agent for the undersigned to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care that is
deemed advisable by, and is to be rendered under the general or special supervision of any physician or surgeon licensed under the provision of the California
Medical Practice Act, on the medical staff of an accredited hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said
hospital.
It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and
power on the part of the above mentioned agent(s) to give specific consent to any and all such diagnosis, treatment or hospital care that the designated physician
in the exercise of his/her office or best judgment may deem advisable. This authorization shall remain effective throughout our son/daughter’s four years at Bishop
O’Dowd and your yearly consent on the emergency treatment update which is completed at re-registration will serve as validation of this signature, unless sooner
revoked in writing and delivered to the designated agent(s). I understand that the school does not assume any responsibility for payment to physician in any case.
However, in an emergency, the school may choose a physician. I also authorize the release of my son/daughter to drive home after an emergency situation or to be driven
home by an authorized person when the situation has been deemed safe by administrator’s in charge at Bishop O’Dowd.
Mother’s Signature & Date: _____________________________________
Father’s Signature & Date: ______________________________________
Legal Guardian Signature & Date: ___________________________________________
PLEASE FILL OUT BOTH SIDES

Last Name:____________________
In addition to the California School Immunization Record (large blue card), please provide the following health information
Preferred Hospital: ____________________________________________
Medical Record Number: ________________________________________
Allergies__________________________________________________________________________________________
Asthma _____________ Frequent Nosebleeds_________________ Frequent Headaches or Migraines______________
Fainting spells__________________ Heart____________________ Other_____________________________________
Diabetes_____________________ Taking Insulin____________ Oral_______________ Injection __________________
Epilepsy_____________________ on medication for Epilepsy_______________________________________________
Any other Disease/Condition that could result in need of medical attention:
(explain)__________________________________________________________________________________________
Other Medications: Specify_____________________________ Reason________________________________________
Side Effects________________________________________________________________________________________
_________________________________________________________________________________________________
In a school wide emergency, students will only be released to parents, guardians, or those designated on this form unless
otherwise specified below.
In case of a school wide emergency, I, the parent/guardian or the above named child, authorize my child to do the
following:
Walk home Take public transportation home Drive self home
Be transported by another student Student’s name _____________________________ Student’s grade ________
Be released to another adult Adult’s name _______________________________

Proof of Insurance – International Student Registration
This Form and Supporting Documents Must Be Submitted by July 1, 2010
to Complete Registration
International students at Bishop O’Dowd High must provide proof of insurance by an American
Insurance Company. (One website that has information on insurance for international scholars
is http://www.betins.com/.)
Please fill in the requested information on this form and attach a copy of the student’s
insurance card.
Medical Insurance
Student’s Name (Please Print):
__________________________________________
The above named student is currently covered by an American Insurance Company:
Name of Company:
_________________________________________________
Address of Company: _________________________________________________
___________________________________________________________________
___________________________________________________________________
Claims Phone:
Group Number:
Plan:
Dates of Coverage:
_________________________________________________
_________________________________________________
_________________________________________________
______________________ to ________________________
Be sure to attach a copy of the student’s insurance card.

Physical Activity and Transportation Forms
This form must be returned by July 1, 2010 to complete your registration.
Pre-participation and Athletic Physical Form
Athletes, Freshmen, and Transfer students must have a physical before entering school and/or participating in
physical education classes and in the athletics program. Please complete the enclosed Pre-participation Physical
Evaluation, complete and sign page 1, and have page 2 completed and signed by your physician. The
Physical Evaluation is due by July 1, 2010.
Transportation Form
Participation in school sponsored activities may involve travel beyond the confines of the Bishop O'Dowd High School
campus. Bishop O'Dowd High School will attempt to coordinate transportation to and from school sponsored
activities. However, there will be occasions when Bishop O'Dowd High School may not provide transportation. On
these occasions, it is the responsibility of the parent or guardian of each student to provide transportation.
Bishop O'Dowd High School may facilitate transportation associated with school sponsored activities by utilizing
buses, employee driven school owned vehicles, and/or parent volunteer driven private vehicles. In instances where
private vehicles are used, the drivers of those vehicles may subject themselves and their own insurance to risk and
liability for the benefit of the school and the school sponsored activity. There will be occasions when students will
make transportation arrangements without using the school organized transportation. The school needs written
permission for this to occur.
I certify that I have read the statement above. I hereby consent to the transportation of my child to and from an
event/school sponsored activity in a privately owned vehicle operated by another parent, thereby releasing Bishop
O'Dowd High School and its staff of all liability.
I agree.
Signature:
Date:
_______________________________________________
_______________________________________________
Please Print Your Name:
_______________________________________________
Please Print Student’s Name:
_______________________________________________

Bishop O'Dowd High School
9500 Stearns Ave Oakland, CA 94605
Phone: (510) 577-9100 Fax: (510) 638-3259
Pre-participation Physical Evaluation (Page 1 of 2)
Part 1. Student Information (The parent or guardian should fill out this form with assistance from the student)
Name Sex Age Date of Birth Grade
Address
Phone
In case of emergency, contact:
Name:
Phone (H): (W) Cell Phone:
Part 2. Medical History (The parent or guardian should fill out this form with assistance from the student). Explain “yes” answers
below. Circle questions you don’t know answers to.
Yes No
1. Have you had a medical illness or injury since your last check-up
or sports physical? O O
Do you have an ongoing or chronic illness? O O
Are you currently being treated for an injury or condition? O O
2. Have you ever been hospitalized overnight? O O
Have you ever had surgery? O O
3. Are you currently taking any prescription or nonprescription
(over-the-counter) medications or pills or using an inhaler? O O
Have you ever taken any supplements or vitamins to help you
gain or lose weight or improve your performance? O O
4. Do you have any allergies to medications? O O
Do you have any allergies to pollen, food or stinging insects? O O
Have you ever had a rash or hives develop during or after
exercise? O O
5. Have you ever passed out during or after exercise? O O
Have you ever been dizzy during or after exercise? O O
Have you ever had chest pain during or after exercise? O O
Do you get tired more quickly than your friends during exercise? O O
Have you ever had racing of your heart or skipped heartbeats? O O
Have you had high blood pressure or high cholesterol? O O
Have you ever been told you have a heart murmur? O O
Have you had a severe viral infection (i.e., mononucleosis or
myocarditis) within the last month? O O
Has a doctor ever denied or restricted your participation in
sports for any heart problems? O O
Has anyone in your immediate family had the following conditions? O O
Diabetes Heart disease other
Sudden death prior to age 50 High Blood Pressure
6. Do you have any current skin problems (for example, itching,
rashes, acne, warts, fungus, or blisters)? O O
7. Have you ever had a head injury or concussion? O O
Have you ever been knocked out, become unconscious, or
lost your memory? O O
Have you ever had a seizure? O O
Do you have frequent or severe headaches? O O
Have you ever had numbness or tingling in your arms, hands,
legs, or feet? O O
Have you ever had a stinger, burner, or pinched nerve? O O
8. Have you ever become ill from exercising in the heat? O O
Yes No
9. Do you cough, wheeze, or have trouble breathing during or
after activity? O O
Do you have asthma? O O
Do you use an inhaler? O O
Do you have seasonal allergies that require medical treatment? O O
10. Do you use any special protective or corrective equipment
or devices that aren’t usually used for your sport or position
(for example, knee brace, special neck roll, foot orthotics, O O
retainer on your teeth, hearing aid)?
11. Have you had any problems with your eyes or vision? O O
Do you wear glasses, contacts, or protective eyewear? O O
12. Have you ever had a sprain, strain, or swelling after injury? O O
Have you broken or fractured any bones or dislocated any
joints? O O
Have you had any other problems with pain or swelling in
muscles, tendons, bones, or joints? O O
If yes, check appropriate box below.
O Head O Elbow O Hip
O Neck O Forearm O Thigh
O Back O Wrist O Knee
O Chest O Hand O Shin/calf
O Shoulder O Finger O Ankle
O Upper arm
O Foot
13. Do you want to weigh more or less than you do now? O O
Do you lose weight regularly to meet weight requirements
for your sport? O O
14. Do you feel stressed? O O
15. Do you or have you ever used: O O
Smokeless tobacco
Cigarettes
Alcohol
Recreational drugs
Females Only
16. When was your first menstrual period?
When was your most recent menstrual period?
How much time do you usually have from the start of one period to the start
of another?
How many periods have you had in the last year?
What was the longest time between periods in the last year?
Explanation:
I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.
I understand and acknowledge that truthful and accurate information is essential in properly determining whether the student should be cleared for
athletic participation and physical education.
I hereby consent for the student named above, to be given medical care by the doctor selected by the school.
Signature of Parent/Guardian Signature of Student Date

Bishop O'Dowd High School
9500 Stearns Ave Oakland, CA 94605
Phone: (510) 577-9100 Fax: (510) 638-3259
Preparticipation Physical Evaluation (Page 2 of 2)
Part 3. Physical Examination (to be completed by physician)
Name: ______________________________________________________________ Date of Birth: ____________________
Height: ______ Weight: _______ % Body Fat (optional)_______ Pulse: ______ BP: ____/____ (____/____,_____/_____)
Vision: R 20/ _______ L 20/ _______ Glasses/Contacts: Yes No Pupils: Equal Unequal
Findings Normal Abnormal Findings Initials*
Medical
Appearance
Skin
Eyes/Ears/Nose
Throat/ Oropharynx
Lymph Nodes
Heart
Pulses
Lungs
Abdomen
Genitalia/ Hernia
Musculoskeletal
Neck
Back
Shoulder/arm
Elbow/forearm
Wrist/hand
Hip/thigh
Knee
Leg/ankle
Foot
*Station-based examination only
Assessment
Cleared
Cleared after completing evaluation/rehabilitation for:
Not Cleared for:
Recommendations:
Reason:
Name of physician (print/type)
Address:
Signature of physician:
Date
Phone: ______________________
,MD
Preparticipation Physical Evaluation Forms are based on recommendations developed by the American Academy of Family Physicians,
American Academy of Pediatrics, American Medical Society for Sports Medicine and American Osteopathic Academy for Sports Medicine.

TO THE APPLICANT:
Bishop O’Dowd High School
Final Transcript Release Form
DUE JULY 1, 2010
Please complete this form and give it to the counselor, eighth grade teacher or registrar at your
current school. Please provide them with an envelope addressed to Bishop O’Dowd High
School – Admissions, 9500 Stearns Avenue, Oakland CA 94605.
STUDENT: __________________________________________________
Last Name First Middle Initial
PARENT/GUARDIAN: ________________________________________
Last Name First Middle Initial
D.O.B _____________
Phone _____________
ADDRESS:_____________________________________________________________________________
Street City State Zip Code
PRESENT SCHOOL: _____________________________________________________________________
ADDRESS OF SCHOOL: ___________________________________________________________________
Street City State Zip Code
PARENT AUTHORIZATION FOR THE RELEASE OF RECORDS:
The undersigned hereby consents to the release of all education records for the above named student to Bishop
O’Dowd High School.
____________________________________________
Signature of Parent or Guardian
_____________________________
Date
TO THE COUNSELOR/REGISTRAR OR EIGHTH GRADE TEACHER OF CURRENT
SCHOOL:
The above named student is an applicant for admission to Bishop O’Dowd High School. Upon completion of the
school year, please send this form and the official transcript or final report card for the student named above by
June 30 th .
Signature of Principal, Counselor, Eighth Grade Teacher or Registrar
Date

Student Acknowledgement Form
Please read the 2010-2011 Bishop O'Dowd Student-Parent Handbook which can be found at
http://www.bishopodowd.org/s/770/images/editor_documents/Academics/Final%20Student-
Family%2010-11_3_15_10.pdf. You may also access this link through the Parents & Families page on
the Bishop O’Dowd website: www.bishopodowd.org. Acknowledge the statements below to verify that
you have read and agree to abide by the stated school policies.
I, THE BELOW NAMED STUDENT, ACKNOWLEDGE AS FOLLOWS:
1. I have read the 2010-2011 Bishop O'Dowd Student-Parent Handbook, and agree to be
governed by all policies, procedures, and expectations contained in the handbook.
2. I have read and will abide by the Technology Acceptable Use Policy located in the 2010-2011
Bishop O'Dowd Student-Parent Handbook. I understand that this policy applies to all
technology resources including, but not limited to: computers, cell phones, iPhones, video and
audio equipment, PDAs, copy machines, and information storage devices. I understand that any
violation of the policy may result in revocation of my technology privileges, school disciplinary
action, including suspension or expulsion, or criminal charges.
3. I have carefully read the Statement of Integrity located in the 2010-2011 Bishop O'Dowd
Student-Parent Handbook. I understand that I will compose all of my own writing assignments,
and that I will cite the source of any information or ideas taken from an outside source. I also
understand Bishop O'Dowd's policy regarding cheating and the importance of personal integrity
as essential for building community and promoting social justice. I further understand that I am
expected to conduct myself in an ethical, respectful, and considerate manner when I am at school
and at all school-related activities, athletic events, and social gatherings.
Signature:
Print Your Name:
____________________________________ Date: ____________
____________________________________

Parent Acknowledgement Form
Please read the 2010-2011 Bishop O'Dowd High School Student-Parent Handbook, which can be
found at http://www.bishopodowd.org/s/770/images/editor_documents/Academics/Final%20Student-
Family%2010-11_3_15_10.pdf. You may also access this link through the Parents & Families page on
the Bishop O’Dowd website: www.bishopodowd.org. Acknowledge the statements below to verify that
you have read and agree to abide by the stated school policies.
I, THE PARENT/GUARDIAN OF THE BELOW NAMED STUDENT, ACKNOWLEDGE AS FOLLOWS:
1. I have read the 2010-2011 Bishop O'Dowd High School Student-Parent Handbook, and agree to
be governed by all policies, procedures, and expectations contained in the handbook.
2. I have reviewed the Bishop O'Dowd High School Technology Acceptable Use Policy with my child
and will abide by the terms and conditions of the agreement.
3. As the parent or guardian of this student, I have carefully read the Statement of Integrity located
in the 2010-2011 Bishop O'Dowd High School Student-Parent Handbook. I understand that my
student will compose all of his/her own writing assignments; and that he/she will cite the source of
any information or ideas taken from an outside source. I also understand the policy regarding
cheating and the importance of maintaining personal integrity. I support Bishop O'Dowd's policy
that he/she must conduct him/herself in an ethical, respectful, and considerate manner when at
school and at all school-related activities, athletic events, and social gatherings.
Signature:
Print Your Name:
Student’s Name:
____________________________________ Date: ________________
____________________________________
____________________________________

Host Family Acknowledgement Form
Please read the 2010-2011 Bishop O'Dowd High School Student-Parent Handbook which can be
found at http://www.bishopodowd.org/s/770/images/editor_documents/Academics/Final%20Student-
Family%2010-11_3_15_10.pdf. You may also access this link through the Parents & Families page on
the Bishop O’Dowd website: www.bishopodowd.org. Acknowledge the statements below to verify that
you have read and agree to abide by the stated school policies
I, the host family/guardian of the below named student, acknowledge as follows:
1. I have read the 2010-2011 Bishop O'Dowd High School Student-Parent Handbook, and agree to
be governed by all policies, procedures, and expectations contained in the handbook.
2. I have reviewed the Bishop O'Dowd High School Technology Acceptable Use Policy with the
student and will abide by the terms and conditions of the agreement.
3. As the host family and/or guardian of this student, I have carefully read the Statement of Integrity
located in the 2010-2011 Bishop O'Dowd High School Student-Parent Handbook. I understand
that the student will compose all of his/her own writing assignments; and that he/she will cite the
source of any information or ideas taken from an outside source. I also understand the policy
regarding cheating and the importance of maintaining personal integrity. I support Bishop
O'Dowd's policy that he/she must conduct him/herself in an ethical, respectful, and considerate
manner when at school and at all school-related activities, athletic events, and social gatherings.
Signature:
Print Your Name:
Student’s Name:
____________________________________ Date: ________________
____________________________________
____________________________________

Educational Support
In order for Bishop O'Dowd to provide the appropriate learning needs assistance
to your child, please answer the following questions:
Does your child have a physical or mental disability? _______________
If “yes,” please describe the disability:
________________________________
________________________________________________________________
________________________________________________________________
Does your child have a documented learning disability or diagnosed Attention
Deficit with established accommodations? __________________
If “yes,” please describe the learning disability or Attention Deficit: ___________
________________________________________________________________
________________________________________________________________
If “yes,” please attach documentation regarding this disability or Attention Deficit.

Family Educational Rights and Privacy Act (FERPA)
FERPA is a federal law that protects the privacy of student education records. This law requires Bishop O'Dowd High
School to obtain your written consent prior to the disclosure of personally identifiable information from your student's
school records.
Schools may disclose, without consent, "directory" information such as a student's name, address, telephone
number, date and place of birth, honors and awards, and dates of attendance. However, schools must tell parents
and eligible students about directory information and allow parents and eligible students a reasonable amount of time
to request that the school not disclose directory information about them.
To publicize the achievements of our students, Bishop O'Dowd High School occasionally publishes certain student
information. Some of this information is also released to outside organizations such as companies that manufacture
class rings and yearbooks. This information can include:
Name
Photo
Address/telephone listing
Electronic e-mail address
Date and place of birth
Grade level
Dates of attendance
Participation in officially recognized activities and sports
Height and weight of athletes
Please read and indicate whether or not you give permission for use of this information.
I hereby grant Bishop O'Dowd High School permission to publish my student's information such as name, parent
name, address, phone #, grade level and electronic e-mail address in the School Directory. (Name, parent name,
address, phone #).
_______Yes
_______ No
I hereby grant Bishop O'Dowd High School permission to publish photographs, print and web-based materials of my
son's/daughter's likeness or student information such as directory information, academic information, and athletic
achievements in press releases, playbills, programs, yearbooks, etc.
_______Yes
_______ No
I hereby grant Bishop O'Dowd High School and/or its agents, permission to videotape/photograph/record/interview
my son's/daughter's likeness and/or voice at Bishop O'Dowd High School for the purpose of obtaining live or still
images or voice commentary for school publications and/or media productions. The purpose of said efforts would be
to demonstrate the qualities of Bishop O'Dowd High School, its teachers, students, academic, religious, and
community service environment. Productions/ads/publications, etc. would be shown to students, prospective
students, parents, supporters, and are not intended for commercial resale.
_______ Yes
_______ No
Parent Signature:
Print Parent Name:
___________________________ Date: ___________________
________________________________
Print Student Name: ________________________________

BISHOP O’DOWD HIGH SCHOOL
PARENT PERMISSION TO PARTICIPATE IN ORIENTATION AND FIELD TRIPS
International Student Orientation
My child, the student named below, will be participating in the International Student Orientation
from July 26, 2010 through August 12, 2010.
I understand that this orientation includes activities away from the school site, and I specifically
give permission for the my child (the student named below) to participate in such activities and to
travel by any of the following methods:
• Bus or van provided by the school.
• Private car of a parent, teacher, administrator or staff member of Bishop O’Dowd High
School.
• Public transportation such as public bus, train, ferry or rapid transit.
I agree to direct my child to cooperate and conform with directions/instructions of the personnel
in charge of any Bishop O’Dowd High School activity. I understand that all school rules remain in
effect during field trips and orientation activities.
I hereby dismiss Bishop O’Dowd High School and the Diocese of Oakland, their staff and
contractors, from any liability in the event of an accident or injury while transporting my
son/daughter to and from field trips or other school sponsored activities while using methods of
transportation other than vehicles (buses or vans) provided by the school.
Name of Student (Please Print):
_________________________________________________
Name of Parent/Guardian (Please Print): ______________________________________________
Relationship to Student:
________________________________________________________
Parent/Legal Guardian Signature ________________________________ Date ________________

Athletic Gold
Mens Polos
color style # size quantity price
color style # size quantity
Bark
822 W. Jefferson St.
Boise, ID 83702
Phone 800-632-6651
Fax (208) 342-8348
michaelf@mcusports.com
BISHOP O’DOWD POLO SHIRT ORDER FORM
XS - XL $25.00
2XL $27.00
3XL $29.00
Black
Blueberry
Ladies Polos
price
Black
Blueberry
Burgundy
Classic Navy
Dark Green
Faded Blue
Faded Olive
Forest
Ivory
Light Blue
Navy
Orange
Oxford
Pistachio
Purple
Royal
Sea Foam
Steel Grey
Stone
White
Yellow
Classic Navy
Faded Blue
Light Blue
Lilac
Navy
Orange
Pink
Pistachio
Purple
Sea Foam
Stone
Turquoise
White
Yellow
Burgundy
Royal
Dark Green
Steel Gray
Oxford
Total
19L
20L
21L
22L
23L
Total
Shipping ($3.75/shirt)
Student Name
GRAND TOTAL
Credit Card
Check
Credit Card Number
Expiration Date
Name on Credit Card
Shipping Info:
Address
Ordering Procedure
1.) E-mail, Fax or Call McU Sports.
2.) When Calling, Ask for Team Sports/Wholesale
Department.
3.) Tell salesperson you want to order a STUDENT
POLO FOR BISHOP O’DOWD.
We will charge a $10.00 re-stock/re-shipping fee per returned order.
For alumni clothing and accessories, check out the Dragon Den web site at www.mcusports.com/odowd/