Hill Cross Country Athletic Participation Agreement
2017 XC Season - Please complete form for each athlete participating in Cross Country.
First Name *
Your answer
Last Name *
Your answer
Grade *
Gender *
Street Address *
Your answer
City/ZIP *
Your answer
Parent/Guardian Name *
Your answer
Parent/Guardian Cell Phone *
Your answer
Parent/Guardian Email Address
Your answer
Optional 2nd Cell Phone
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
I have read and reviewed the Cross Country Information Sheet located here: https://goo.gl/nhNEK6 *
Is a current physical exam on file with the school nurse? *
All students trying out/practicing for a sport must have a current physical exam on file with the school nurse. A current physical exam is one that has been completed within THIRTEEN months of the last day of the season. Physicals are valid for one calendar year.
Medical concerns to be shared with the coaches.
If your child has an inhaler, they are required to have it with them at practice at all times
Your answer
Is your student covered under a school insurance policy? *
If not, your digital signature constitutes a waiver and a confirmation of other insurance coverage. Either home or school medical insurance is required.
Please include the insurance company and the policy number:Your answer
Your answer
Concussion Sign Off Form Completed and Returned to Coaches
See Link on Hill Middle School Cross Country Website: http://hillxc.weebly.com/forms.html
All students will be required to maintain passing grades in order to participate. *
*Three strike rule: 1st strike is a warning, 2nd strike is no games, 3rd strike is no games and no practice until grades are passing in all courses
I understand that I am responsible for transportation home from school at BEFORE 4:45 P.M. (Practice Ends At 4:30) *
Please note that daily practice ends at 4:30 each day. You should plan to pick up your child from practice at that time. (Allow 5-10 minutes for them to get changed) If transportation can not be arranged before 4:45, athletes should not attend practice that day.
I have signed up for the team text alert system, located here: https://www.remind.com/join/hill-xc *
Athletes are asked to pay a $125.00 fee per sport ($250.00 for two or more). Please send a check payable to Hill Middle School with your phone number and the student's ID# prior to our first meet (September 1st). *
Digital Signature of Parent/Guardian - Please type in the first and last name of the parent/guardian that is filling out this form. This constitutes written permission to participate in the Middle School Athletic Program and understanding of the inherit risk involved. *
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
Your answer
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