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Nashoba Tech Athletics Registration 2018-2019
Please fill out the following form with the necessary information. After the various documents type the parent/guardian's name.
This will serve as official sign-ups and satisfy the necessary state and district paperwork requirements. If you have any questions please contact James Creed at jcreed@nashobatech.net
Email address *
Student's First Name *
Your answer
Student's Last Name *
Your answer
Parent/Guardian Email Address *
Your answer
Emergency Contact Phone Number 1 (Name and Number) *
Your answer
Emergency Contact Phone Number 2 (Name and Number) *
Your answer
What Grade will your child be in for 2017-2018 School Year *
Fall Sport
Winter Sport
Spring Sport
Physicals* Nashoba Valley Technical High School requires all student athletes to have an active physical. Physicals are active for 13 Months and a copy needs to be kept in the nurse's office. What Month in August - December of 2016 or 2017 was your child's last physical? *
Required
Chemical Health *This agreement between students, their parents or guardians, and Nashoba Valley Technical High Schools is designed to serve several purposes. It is intended to influence students to make wise and legally sound decisions. It is also designed: • To help ensure the physical and mental health of students; • To enable student athletes and leaders to set an example of responsible behavior; • To promote zero-tolerance of under age (21 years) drinking as defined by federal and state laws, as well as of the use of illegal and harmful chemical substances among our youth; • To bind the community together in support of its students; This agreement was first developed by the Massachusetts Interscholastic Athletic Association (MIAA), and was created in pursuant to the rules of the MIAA. To maintain membership, we must adhere to and enforce the MIAA policy. RULE During the season of practice or play, a student shall not, regardless of the quantity, use, consume, possess, buy/sell, or give away any beverage containing alcohol; any tobacco product; marijuana; steroids; or any controlled substance. As defined under, Mass General Laws, Ch 90D. This policy includes products such as “NA or near beer”. Or intake the vapors of any intoxicating substance, such as glue, nitrous oxide and the like, sometimes referred to as “huffing”. It should be noted that: If a student in violation of this rule is unable to participate in interscholastic sports due to injury or academics, the penalty will not take effect until that student is able to participate again. The rule is in effect from the earliest fall practice date to the conclusion of the academic year or final athletic event (whichever is latest). • 1st Offense: When the Principal confirms, following an opportunity for the student to be heard, that a violation occurred, the student shall lose eligibility for a minimum of 25% of the season or next season of participation. Penalties carry to the following season. If the student is unable to participate due to injury, academics or otherwise, the penalty will not take effect until that student is able to participate again. • 2nd offense and subsequent offense: The student will lose eligibility for a minimum of 60% of the season or next season of participation. The student must also attend at least three approved substance abuse sessions. • In either instance, further disciplinary action may be taken by the school, including informing legal authorities or mandating drug and alcohol counseling. • Also be reminded of the Principal’s Authority to Suspend and/or Expel Under the terms of the Education Reform Act and MGL, Section 37 H, the principal of a school containing grades nine through twelve has the authority to immediately suspend and/or expel a student under the following conditions: found on school premises or at school sponsored or school related events, including athletic games, in possession of a dangerous weapon, including but not limited to a gun or a knife; or possession of a controlled substance as defined in MGL 94 C I have read and understand this policy. *
Hazing* HAZING INFORMATION: Be it enacted by the Senate and House of Representatives in General Court assembled, and by the authority of the same, as follows: Chapter 269 of the General Laws is hereby amended by adding the following three sections: Section 17: Whoever is a principle organizer or participant in the crime of hazing as defined herein shall be punished by a fine of not more than one thousand dollars or by imprisonment in a house of correction for not more than one hundred days, or by both such fine and imprisonment. The term "hazing" as used in this section and in sections eighteen and nineteen, shall mean any conduct or method of initiation into any student organization, whether on public or private property, which willfully or recklessly endangers the physical or mental health of any student or other person. Such conduct shall include whipping, beating, branding, forced calisthenics, exposure to the weather, forced consumption of any food, liquor, beverage, drug or other substance, or any other brutal treatment or forced physical activity which is likely to adversely affect the physical health or safety of any such student or other person, or which subjects such student or other person to extreme mental stress, including extended deprivation of sleep or rest or extended isolation. Section 18: Whoever knows that another person is the victim of hazing as defined in section seventeen and is at the scene of such crime shall, to the extent that such person can do so without danger or peril to himself or others, report such crime to an appropriate law enforcement official as soon as reasonably practicable. Whoever fails to report such crime shall be punished by a fine of not more than five hundred dollars. Section 19: Each secondary school and each public and private school or college shall issue to every group or organization under its authority or operating on or in conjunction with its campus or school, and to every member, or applicant for membership in such group organization, a copy of this section and sections seventeen and eighteen. An officer of each such group or organization, and each individual receiving a copy of said sections seventeen and eighteen shall sign an acknowledgment stating that such group, organization or individual has received a copy of said sections seventeen and eighteen. Each secondary school and each public or private school or college shall file, at least annually, a report with the regents of higher education and in the case of secondary schools, the board of education, certifying that such institution has complied with the provisions of this section and also certifying that said school has adopted a disciplinary policy with regards to the organizers and participants of hazing. The board of regents and in the case of secondary schools, the board of education shall promulgate regulations governing the content and frequency of such reports, and shall forthwith report to the attorney general any such institution, which fails to make such report. Passed to be enacted by the House of Representatives November 13, 1985. Passed to be enacted by the Senate November 14, 1985. Approved November 26, 1985 by Governor Michael J. Dukakis. I have read and understand this information *
Concussions * Student Athletes are required to take the impact baseline test every other year. If you need to take the impact test please visit the website below and use the password SC3PFGB9PT https://www.impacttestonline.com/testing/ *
On March 14, 2016, Governor Charlie Baker signed landmark legislation into law to address the deadly opioid epidemic plaguing the Commonwealth. The bill is titled An Act relative to substance use, treatment, education and prevention (STEP Act). Below is a link to information about drug abuse and education. http://www.mass.gov/eohhs/gov/departments/dph/programs/community-health/dvip/injury-prevention/substance-use-disorder.html. *I have read and watch videos pertaining to drug abuse and prevention. *
Parent Consent form* I, the parent or guardian of student, a minor, do hereby consent to my child’s participation in voluntary athletic or recreation programs of the Nashoba Valley Technical High School, 100 Littleton Road, Westford, MA.I also agree to forever release Nashoba Valley Technical High School District, the School Committee, and all their employees, agents, board members, volunteers and any and all individuals and organizations assisting or participating in voluntary athletic or recreation programs of Nashoba Valley Technical High School District (“the Releasees”) from any and all claims, rights of action and cause of action that may have arisen in the past, or may arise in the future, directly or indirectly, from personal injuries to my child or property damage resulting from my child’s participation in the Nashoba Valley Technical High School District recreation programs.I also promise, to indemnify, defend, and hold harmless the Releases against any and all legal claims and proceeding of any description that may have been asserted in the past, or may be asserted in the future, directly or indirectly, a rising from personal injures to my child or property damage resulting from my child’s participation in the Nashoba Valley Technical High School District of voluntary athletic or recreation programs.I further affirm that I have read this Consent and Release Form and that I understand the contents of this Form. I understand that my child’s participation in these programs is voluntary and that my child and I are free to choose not to participate in the Nashoba Valley Technical High Schools athletic or recreation programs with full knowledge that the Releases will not be liable to anyone for personal injuries and property damage my child or I may suffer in voluntary Nashoba Valley Technical High School athletic or recreation programs. I have read and understand the consent form. *
Health History* Please indicate if your child has a physician verified allergy *
If your child has an allergy please 1) the allergy (s) 2) if Epi Pen is require 3) If Benadryl is required 4) Asthma Inhaler 5)Do they carry his/her own Epi Pen
Your answer
Medical Release* I understand that the Nashoba Technical High School has a responsibility to my on/daughter to use responsible and prudent judgement in maintaining his/her health while engaged in the school's program. With this in mind and in my absence: In the treatment (including emergency surgery) by an area doctor, hospital or other appropriate medical facility. I have read and understand this policy. *
I grant the school nurse permission to share health information about my child including medication, Health Pare Provider Release, and Medication Permission, on a need to know basis with his/her coach *
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