Please fill out all information and then click SUBMIT at the bottom of the form.

Belleville East High School Online Athletic Registration: Athletes and parents must complete the online registration before trying out for a sport. Completion of this process does NOT guarantee the student athlete will be a member of the team. Coaches will make decisions on final rosters for each sport upon completion of tryouts.
A current physical (within 395 days) must be on file with the school nurse BEFORE an athlete will be allowed to tryout or practice.
A $30 participation fee per sport must be paid once the student has made the final roster. No uniform will be issued until this fee is paid. Checks can be made payable to BTHS201 and paid in the bookstore or by credit card through your parent portal/fees tab.
*In typing in your name (Parent/Guardian & Student) in this registration, you signify that your electronic signature represents the person named and acknowledges a full understanding & acceptance of the athletic rules and agreement.
*In providing your address, you are confirming that the student-athlete and the parent(s)/court-appointed legal guardian reside full time in the attendance boundaries of Belleville East High School.
Sport:	East Girls Tack & Field
Athlete's First Name:
Athlete's Middle Name:
Athlete's Last Name:
Athlete's ID#:
Grade Level:	9 10 11 12
Gender:	M F
Date of Birth (mm/dd/yyyy):
Street Address:
City:
Zip Code:
Home Phone (xxx-xxx-xxxx):
Mom/Guardian Cell Phone (xxx-xxx-xxxx):
Dad/Guardian Cell number (xxx-xxx-xxxx):
Athlete's Cell Number (xxx-xxx-xxxx):
Mother/Guardian First & Last Name:
Father/Guardian First & Last Name:
Has the student athlete attended any other HIGH SCHOOL other than Belleville East?	Y N
If Yes: Name, City & State of previous high school
If yes, year(s) attended:
Student Athlete lives with:	Both Birth Parents Birth Mother Only Birth Father Only Other
If Other, (What Relation? Be Specific):
Does the student reside full time with parents, custodial parent, or court appointed legal guardian?	Y N
If no, please explain:
Emergency Contact & Relation #1:
Emergency Phone #1 (xxx-xxx-xxxx):
Emergency Contact & Relation #2 (other than a parent/guardian):
Emergency Phone #2 (xxx-xxx-xxxx):
Email Address--To receive confirmation of form submission. Dist. 201 employees must use email address OTHER than bths201.org.
Parent Email:
Athlete Email:
Additional Email Address:
I have read and I understand the Belleville District 201 Athletic Code of Conduct. Except with respect to the use of prescription drugs prescribed for me by a medical doctor when used by me in the manner intended by the prescribing medical doctor, I promise that I will not possess, use, distribute, purchase, or sell any alcoholic beverage, drug, drug paraphernalia, controlled substance, look-alike, tobacco or tobacco product or any other substance which, when taken into the human body is intended to alter mood or mental state, or is intended to be performance enhancing including any item or substance which is represented by me or anyone else to be, or is believed by me or anyone else to be any of the above, regardless of the true nature or appearance of the substance for so long as I am a student athlete within the meaning of the Belleville High School District 201 Athletic Code or subject to it terms and conditions.
I understand that my athletic eligibility is conditioned on my keeping this promise.
Student's Full Name:
Parent/Guardian Full Name:
PERMISSION TO PLAY AND INTENT TO FOLLOW RULES
I am aware that playing or practicing to play any sport can be dangerous involving many RISKS OF INJURY. I understand that the dangers of playing or practicing include but are not limited to death, serious neck and spinal cord injuries which may result in paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles and all other elements of the skeletal/muscular system.
I recognize the dangers of practicing or playing and agree to assume the risk. I also recognize the importance of following the coaches and instruction regarding skills, safety, and team rules.
My son/daughter has my permission to play/practice in school-sponsored sports. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and for all members of my family.
Student's Full Name:
Parent/Guardian Full Name:
INSURANCE WAIVER
The Board of Education of District 201 assumes no liability for accidents and does not carry accident or health insurance on athletic programs. The board recognizes that a family may wish insurance protection that the school cannot provide.
My signature below indicates that I have personal health insurance to cover my son/daughter should an injury occur or I have secured student accident insurance for my son/daughter.
Parent/Guardian Full Name:
EMERGENCY MEDICAL CARE
I realize that in the case of an emergency it may be necessary to provide immediate medical care. I consent to allow my child to be treated at the nearest medical facility in the event of such emergency.
Parent/Guardian Full Name:
Physicals are only good for 395 days. Athletes must have a current physical that will last through the whole season. A copy of a current physical must be on file with the school nurse prior to tryouts. Student athletes will NOT be allowed to participate in tryouts without a copy of a current physical. See the registration page for blank physical forms and site listings for affordable physicals.
Date of most Recent Physical:
Family Doctor Name, Location, Phone #:
Please list any health concerns, eg. allergies, asthma, etc.:
Allergies- List all:
Other Medical Concerns:
Insurance Company:
Hospital Preference:
Primary Care Provider:
I have read and I understand the I.H.S.A. ELIGIBILITY RULES as stated in the student handbook, and the IHSA CONCUSSION INFORMATION SHEET (all are linked on the BTHS Athletic Online Registration page). As a condition of participation, I agree to abide by them and have signed below.
Student's Full Name:
Parent/Guardian Full Name:
Parent and Student Agreement/Acknowledgement Form Performance-Enhancing Substance Testing Policy
• Illinois state law prohibits possessing, dispensing, delivering or administering a steroid in a manner not allowed by state law. • Illinois state law also provides that body building, muscle enhancement or the increase in muscle bulk or strength through the use of a steroid by a person who is in good health is not a valid medical purpose. • Illinois state law requires that only a licensed practitioner with prescriptive authority may prescribe a steroid for a person. • Any violation of state law concerning steroids is a criminal offense punishable by confinement in jail or imprisonment in the Illinois Department of Corrections.
STUDENT ACKNOWLEDGEMENT AND AGREEMENT
As a prerequisite to participation in IHSA athletic activities, I agree that I will not use performance-enhancing substances as defined in the IHSA Performance-Enhancing Substance Testing Program Protocol. I have read this form and understand that I may be asked to submit to testing for the presence of performance-enhancing substances in my body, and I do hereby agree to submit to such testing and analysis by a certified laboratory. I understand that testing may occur during selected IHSA state series events or during the school day. I further understand and agree that the results of the performance-enhancing substance testing may be provided to certain individuals in my high school as specified in the IHSA Performance-Enhancing Substance Testing Program Protocol which is available on the IHSA website at www.IHSA.org. I understand and agree that the results of the performance-enhancing substance testing will be held confidential to the extent required by law. I understand that failure to provide accurate and truthful information could subject me to penalties as determined by IHSA.
Student's Full Name:
PARENT/GUARDIAN CERTIFICATION AND ACKNOWLEDGEMENT
As a prerequisite to participation by my student in IHSA athletic activities, I certify and acknowledge that I have read this form and understand that my student must refrain from performance-enhancing substance use and may be asked to submit to testing for the presence of performance-enhancing substances in his/her body. I understand that testing may occur during selected IHSA state series events or during the school day. I do hereby agree to submit my child to such testing and analysis by a certified laboratory. I further understand and agree that the results of the performance-enhancing substance testing may be provided to certain individuals in my student’s high school as specified in the IHSA Performance-Enhancing Substance Testing Program Protocol which is available on the IHSA website at www.IHSA.org. I understand and agree that the results of the performance enhancing substance testing will be held confidential to the extent required by law. I understand that failure to provide accurate and truthful information could subject my student to penalties as determined by IHSA.
Parent/Guardian Full Name:
Relationship to student:
ATHLETIC TRAINER'S CONSENT FOR TREATMENT
I, the Parent /Guardian of the above name student understands that my student-athlete may be injured while participating in school sponsored athletics. I hereby grant permission to physicians covering BTHS 201 athletic events and BTHS Certified Athletic Trainer to administer any preventative, first aid or emergency treatments to evaluate and examine, which they deem reasonably necessary to the health and well-being of my student-athlete. I further understand and consent to the Certified Athletic Trainer’s providing advice to my student athlete concerning nutrition, hydration, and conditioning. The Certified Athletic Trainer may also provide to my student athlete hot or cold packs, wound care, taping, massage, whirlpool treatment and therapeutic exercises which I also authorize and consent to be performed on my student-athlete during his/her participation in school sponsored athletics.
Parent/Guardian Full Name:
DISTRICT 201 CO-CURRICULAR TRANSPORTATION
Students may drive or be driven in privately owned vehicles (other than motorcycles) to practices, games, contests or competitions within the District 201 boundaries only. Parents must be informed and agree that students may drive themselves, may drive other students, may be transported by and with other students, or drive with coaches. For practices and competitions outside the District 201 boundaries, the district will provide transportation. The St. Clair Bowl and The Orchards golf course are treated as if in the district for these purposes.
At out-of-district events, parents sometimes wish to personally transport students after the event rather than have the student ride district-provided transportation back to school. To do that, the parent or legal guardian must personally, face-to-face, inform the coach of that intention after the contest. Student-athletes may not leave with anyone other than the parent or legal guardian unless the parent or guardian had provided a written note specifying the particular adult who has permission to transport his or her student.
PARENTAL AGREEMENTS AND ACKNOWLEDGEMENTS
I acknowledge that the driver’s vehicle insurance is primary.	Y N
If I am permitting my student to drive, I assure that the vehicle he or she is driving is properly insured and safe.	Y N Student is not old enough to have their driver’s license
My student may drive himself or herself.	Y N Student is not old enough to have their driver’s license
My student may drive other students.	Y N Student is not old enough to have their driver’s license
My student may ride with other students.	Y N
My student may ride with a coach.	Y N
Comments or clarifications:
Parent/Guardian Full Name: