Boys Cross Country 18-19

Neuqua Valley High School Online Athletic Registration 2018-2019

In order to participate in tryouts you must:

1. Be a registered student.

~ In providing your address, you are confirming that the student-athlete and the parent(s)/guardian(s) reside full time in the attendance boundaries of our school.

2. Be registered online for athletics.

~ 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.

3. Have a current physical, good through the entire season, on file.

~ A current physical needs to be on file in the Health (Nurse's) Office prior to the first day of tryouts.

~ Coaches will have access to viewing the list of students that are compliant with their physical exam status.

~ If a current physical exam is not on file in the health office, the athlete will not be allowed to tryout.

4. Have passed 5 classes in the previous semester.

5. Have insurance.

Athletic participation fee is $200 per sport (fee is waived for the third season if an athlete has already participated in two previous sports, or qualifying activities, in the current school year). This participation fee should be paid in the webstore on PUSH COIN (pushcoin.com)

After the first 10 days of a season (from first official starting date), participation fee refunds will be issued only for medically documented reasons. Students that quit a team are not eligible for a refund.

Uniforms will only be issued to those that have paid their participation fee or made at least a $50 payment on PUSH COIN.

Sport	*	Boys Cross Country
Team Manager (Check this box ONLY if you are participating as a team manager for this sport.)		Mgr.
Athlete's First Name	*
Athlete's Middle Name/Initial:	*
Athlete's Last Name	*
Student ID #	*
Grade Level	*	9 10 11 12
Gender	*	Male Female
Date of Birth	*
Street Address	*
City	*	Naperville Bolingbrook Plainfield Aurora
Zip Code	*	60564 60565 60490 60585 60544 60502 60563 60504 60540
Home Phone Number	*
Cell Phone Number	*

Parent/Guardian First & Last Name	*
Phone Number	*
Parent/Guardian First & Last Name:
Phone Number
Emergency Contact	*
Relationship	*
Phone Number	*
Emergency Contact
Relationship
Phone Number
Athlete Email	*
Email Address- To receive confirmation of form submission Dist. 204 Employees must use email address OTHER than ipsd.org
Parent/Guardian Email	*

Indian Prairie School District #204 DOES NOT provide student medical accident insurance for athletes until $25,000 has either been expended by your insurance company or payments directly from you for a specific injury. Indian Prairie School District #204 DOES have liability insurance for our buildings and staff members.
I hereby acknowledge the requirement of Indian Prairie School District #204 that all participants in their interscholastic athletic program have insurance. With full knowlege of the preceding, I hereby certify that my son/daughter has insurance coverage for injuries that may occur through participation in the athletic program as offered by Indian Prairie School District # 204.
Do You Have Insurance?	*	Yes No
If you answered Yes, please complete the lines for Insurance Carrier and Policy Number. If you answered No, enter "None" in the Insurance Carrier and Policy Number - be aware that proof of insurance is required for participation. Markel Insurance Company provides student insurance, The online application is available on the school website. Also, the State of Illinois has an "All Kids" insurance program (but it may take a couple of months to get coverage). Premiums are based on income. Call 877-805-5312 for more information.
Insurance Company Name	*
Insurance Policy #	*

Physicals are only good for 395 days from issued date. Athletes must have a current physical that will last through the whole season. A copy of or proof of a current physical must be turned in to the Health Office by the 1st day of tryouts. Student athletes will NOT be able to participate in tryouts without a copy of or proof of a current physical. See the registration page for blank physical forms.
Date of most Recent Physical	*
Doctor Name/ Clinic Name	*
Location
Phone #
Please list any health concerns, i.e. allergies, asthma, etc.
Allergies	*
Medical Concerns:	*

Have you attended another high school?	*	Yes No
If so, please list the High School(s) and the years attended.
High School(s) previously attended
Have you passed 5 classes in the previous semester?	*	Yes No
Are you currently a full time student (minimum 5 classes)?	*	Yes No

Athletic Agreement:
Read, then type STUDENT'S FULL NAME. I would like to participate in the interscholastic athletic program with the full understanding that I will: 1) Keep myself physically fit and abide by all training rules. Any infraction may result in temporary or permanent suspension from the athletic program. 2) Assume all responsibility for athletic equipment issued to me and agree to pay for any loss or damaged equipment. 3) Attend practice regularly and be on time. 4) Be present in school on the day of practices/games. 5) Transfer from one sport to another during the season only with the consent of the athletic director and coaches involved. 6) Respect authority and show good citizenship at all times. 7) Use the school bus to and from activities unless special permission is issued by coach to travel with parents. 8) Be well-groomed. 9) For clarification of rules, I will consult with the Athletic Director.

Student's Full Name	*

Parent Agreement
I approve of my child's request to participate in the athletic program and approve of the statements covering parent or guardian's responsibilities. I also agree to allow my son/daughter to be photographed and release of pictures to newspapers, publications, internet, etc....for the purpose of promoting and reporting our Athletic Program. I give permission for medical care to be given to my son/daughter by the Athletic Trainers in the event of an injury.
Parent/Guardian Full Name	*

I have read the and I understand the ATHLETIC / ACTIVITY CODE, the I.H.S.A. ELIGIBILITY RULES as stated in the student handbook, and the IHSA CONCUSSION INFORMATION SHEET (all are linked on the Athletic 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 & Student Agreement/Acknowledgement Form - Performance-Enhancing Substance Testing Policy
1) Illinois state law prohibits possessing, dispensing, delivering or administering a steroid in a manner not allowed by state law. 2) 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. 3) Illinois state law requires that only a licensed practitioner with prescriptive authority may prescribe a steroid for a person. 4) 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 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 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 the IHSA.
Parent/Guardian Full Name	*

Concussion Information: A concussion is a traumatic brain injury. Symptoms may include headache, loss of memory, confusion, dizziness, nausea, vomiting, slurred speech, fatigue, etc. What can happen if my child keeps on playing with a concussion or returns too soon? Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athletes will often fail to report symptoms of injuries. Concussions are no different. As a result, education of administrators, coaches, parents and students is the key to student-athlete's safety. If you think your child has suffered a concussion: Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. IHSA Policy requires athletes to provide their school with written clearance from either a physician licensed to practice medicine in all its branches or a certified athletic trainer working in conjunction with a physician licensed to practice medicine in all its branches prior to returning to play or practice following a concussion or after being removed from an interscholastic contest due to a possible head injury or concussion and not cleared to return to that same contest. In accordance with state law, all IHSA member schools are required to follow this policy. you should also inform your child's coach if you think that your child may have a concussion. Remember it's better to miss one game than miss the whole season. When in doubt, the athlete sits out. For current and up-to-date information on concussions you can go to: http://www.cec.gov/ConcussionInYouthSports/
Student's Full Name	*
Parent/Guardian Name	*

Inherent Risk: While participation in athletics provides student athletes with valuable and constructive experiences of both a social and physical nature, it must be remembered and understood normal participation in games and practices may also bring the possibility of serious injury. While every precaution is taken to safeguard athletes from injury, a certain amount of risk is inherent in athletic participation. I understand the inherent risk involved..
Yes / No	*	Yes No
Student's Full Name	*
Date	*
Parent/Guardian Name	*
Date	*