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Hampden Charter School of Science-Interscholastic Athletic Registration
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Email address *
Student First Name *
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Student Last Name *
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Student Gender *
Student ID Number *
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Home Address *
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Student Grade *
Student Date of Birth *
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Parent/Guardian Name *
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Parent/Guardian Email *
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Parent/Guardian Phone Number *
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Emergency Contact 1-Name *
Your answer
Emergency Contact 1-Phone Number *
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Emergency Contact 2-Name *
Your answer
Emergency Contact 2-Phone Number *
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By filling out this form, I give my student permission to represent Hampden Charter School of Science-East by participating in the sport of: *
By checking the following box, I certify that my son/daughter named above: *
Has my permission to participate in athletics and understands the inherent risks involved with participation. My student is covered by school insurance or insurance comparable to school insurance. My student will wear whatever protective equipment is supplied by the Hampden Charter School of Science and is required to be worn. My student has permission to travel to and from games only by school provided transportation. My student will uphold all rules and regulations as outlined in the HCSS-EAST Student Handbook and MIAA Rules and Regulations.
Required
By Checking this box, I give consent and authorize the school to obtain, through an EMT, Certified Athletic Trainer or Physician of its choice, such medical care as is reasonably necessary for the welfare of the student if he/she is injured in the course of school athletic activities. *
Required
By checking this box, I agree that as a participating member of the Massachusetts Interscholastic Athletic Association, Hampden Charter School of Science is subject to all the regulations and requirements imposed by the organization. *
Required
By checking the following box I agree to the Hampden Charter School of Science Statement of Parental/Student Consent, Release From Liability, and Indemnity Agreement *
I, the undersigned parent/guardian/legal representative of the above-named student, do hereby consent to his/her participation in voluntary athletic, extra-curricular activities, and/or trips, and in consideration of his/her being permitted to so participate. I, on behalf of myself, me heirs, my agents, my representatives, and on behalf of the above-named student to forever RELEASE, acquit, discharge, and covenant to hold harmless the Hampden Charter School of Science and its employees, servants, and, agents, as well as the Hampden Charter School of Science Board of Directors, its former and current members, and its employees, servants and agents from any and all actions, rights of actions, causes of action, charges, and/or claims, in any way related, to arising from and/or growing out of, directly or indirectly, all known personal injuries or property damage or death, which I may now or hereafter have as the parent/guardian/legal representative of said minor, as well as any actions, rights of action, causes of action, charges and/or claims which said minor has hereafter may acquire, either before or after he/she reaches the age of majority, resulting from, relating to, or in any way connected to his/her participation in athletics, extra-curricular activities, and or trips run by, sponsored by, or related to Hampden Charter School of Science. In addition, I, as parent/guardian/legal representative of said minor, agree to indemnity the Hampden Charter School of Science, its employees, servants, and agents, as well as the Hampden Charter School of Science Board of Directors, its former and current members, and its employees, servants, and agents, in the event that any action, charge, and/or claim is brought against the foregoing, which in any way related to, arising from, and/or growing out of, directly or indirectly, my son/daughter's participation in athletics, extra-curricular activities and/or trips run by, sponsored by, or related to the Hampden Charter School of Science.
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