Request edit access
2019-2020 MSHSL Eligibility Brochure
Students: Your participation in high school activities is dependent on your eligibility. PROTECT that eligibility by reviewing with your parent(s)/guardian(s) this summary of Minnesota State High School League rules which govern your participation. Complete regulations are found in the MSHSL Official Handbook which is available at each member high school and which is also posted on the MSHSL Web site: www.mshsl.org. Please keep this brochure for reference, and if there is a question about any rule interpretation, CONTACT YOUR SCHOOL PRINCIPAL OR ATHLETIC/ACTIVITIES DIRECTOR.

I understand I must sign the current eligibility statement prior to participation each school year.

I understand that once I sign the eligibility statement all eligibility rules apply.
- Twelve (12) months of the year;
- Whether I am currently participating or not;
- Continuously from the first signing of the statement.

Parents/Guardians: REVIEW the following rules with your son or daughter. Your role in stressing the value of following these rules cannot be overstated.

General Student Eligibility Checklist *
If you cannot check all 8 items, see your athletic/activities director or principal
Required
Athletic Eligibility Checklist *
If you cannot check all 4 items, see your athletic/activities director or principal.
Required
2019-2020 MSHSL Eligibility Brochure
2019-2020 MSHSL Eligibility Statement
Statement to be signed by the participant from a MSHSL member school and by the participant's parent or guardian each school year prior to participation in that year. Please check all items:
Transfer Student *
Has the Student transferred from another school district in the last 12 months?
Required
If Yes, which District/School?
Your answer
I have read, understand, and acknowledge receiving the 2019-2020 MSHSL Eligibility Brochure, which contains only a summary of the eligibility rules of the Minnesota State High School League. I understand that a copy of the Official Handbook of the MSHSL is on file with the senior high school athletic director and or principal and that I may review it, in its entirety, if I so choose. The Official Handbook and MSHSL bylaws are also posted on the MSHSL website: www.MSHSL.org under Handbook *
Required
We, the student and parent, have reviewed Concussion Management Recommendations for MSHSL Athletes contained in the Eligibility Brochure and on the following website *
Required
I understand that once I sign the eligibility statement all eligibility rules apply: *
Twelve (12) months of the year; Where I am currently participating or not; Continuously from the first signing of the statement through the completion of my high school eligibility.
Required
Regardless of my age I agree to follow all of the MSHSL bylaws in order to be eligible to represent my school in League-sponsored activities. *
Required
I further understand that a member school of the MSHSL must adhere to all of the rules and regulations that pertain to the League athletics/activities a school may sponsor and that local rules may be more stringent, and penalties more severe, than MSHSL rules. *
Required
2019-2020 MSHSL Eligibility Brochure
Student Code of Responsibilities *
A student whose character or conduct violates the Student Code of Responsibilities or is suspended or expelled is not in good standing and is ineligible for a period of time as determined by the principal. While a student not in good standing, a student may not serve any penalty for MSHSL Bylaw violations.
Required
As a student participating in my school's interscholastic activities, I understand and accept the above responsibilities. *
Required
Informed Consent *
By its nature, participation in interscholastic athletics includes risk of injury and the transmission of infectious diseases such as HIV, Hepatitis B, herpes and others. Although serious injuries are not common and the risk of HIV transmission is almost nonexistent in supervised school athletic programs, it is impossible to eliminate all risk. Participants have the responsibility to help reduce that risk. Participants must obey all safety rules, report all physical and hygiene problems to their coaches, follow a proper conditioning program, and inspect their own equipment daily. PARENTS, GUARDIANS OR STUDENTS WHO MAY NOT WISH TO ACCEPT THE RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS FORM. STUDENTS MAY NOT PARTICIPATE IN AN MSHSL-SPONSORED ACTIVITY WITHOUT THE STUDENTS AND PARENT'S/GUARDIAN'S SIGNATURE. I/we have read and understand Informed Consent.
Required
I consent to the athletic trainer or coach treating injuries and authorize them to discuss those injuries with and release any applicable medical information or records relating to those injuries to coaches, school staff and other qualified health care providers as deemed necessary within their scope of practice. *
Required
I further understand that in the case of injury or illness requiring transportation to a health care facility, that a reasonable attempt will be made to contact the parent or guardian in the case of the student-athlete being a minor, but that, if necessary, the student-athlete will be transported via ambulance to the nearest hospital. *
Required
I/we acknowledge the electronic signature confirms I/we have read and reviewed the information contained in the contents of the Eligibility Brochure and Statement. I/we also acknowledge this electronic signature has the same legal effect, validity, and enforceability as a signature in a non-electronic form. *
Required
2019-2020 MSHSL Eligibility Brochure
MSHSL Annual Sports Health Questionnaire
Student's Name (Last Name, First Name, Middle Initial) *
Your answer
Male/Female *
Age *
Your answer
Birth Date *
Your answer
Address (Please include city, state, zip code) *
Your answer
Phone *
Your answer
Grade *
School *
Your answer
Fall Sport *
Select "None" if applicable
Winter Sport *
Select "None" if applicable
Spring Sport *
Select "None" if applicable
All Year Activity *
Select "None" if applicable
MSHSL Sports Qualifying Physical Examination Clearance Form *
A current Sports Qualifying Physical Exam (SQPE) form - valid for three years is needed to register. Does the KAHS Activities office have a copy of the SQPE?
Required
Date of Last Sports Qualifying Physical Exam (SQPE)
Your answer
2019-2020 MSHSL Eligibility Brochure
MSHSL Annual Sports Health Questionnaire
IN THE LAST YEAR, since your last complete Sports Qualifying Physical Exam with your physician or your Year 2 Annual Health Questionnaire, HAVE YOU HAD ANY CHANGES TO THE FOLLOWING QUESTIONS BELOW, Answer Yes or No for each question:
In the last year has a doctor restricted your participation in sports for any reason without clearing you to return to sports? *
Required
IMPORTANT HEART HEALTH QUESTIONS ABOUT YOU IN THE LAST YEAR
In the last year, have you passed out of nearly passed out during or after exercise? *
Required
In the last year, have you had discomfort, pain, tightness, or pressure in your chest during exercise? *
Required
In the last year, does your heart race or skip beats (irregular beats) during exercise? *
Required
In the last year, do you get light-headed or feel more short of breath than expected during exercise? *
Required
In the last year, have you had an unexplained seizure? *
IMPORTANT HEART HEALTH QUESTIONS ABOUT YOUR IN THE LAST YEAR
In the last year, has anyone in your immediate family died suddenly and unexpectedly for no apparent reason? *
In the last year, has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including an unexplained drowning, an unexplained car accident, or Sudden Infant Death Syndrome? *
Required
In the last year, has anyone in your immediate family had instances of unexplained fainting, seizures, or near drowning? *
Required
In the last year, has anyone in your immediate family developed hypertrophic cardiomyopathy, Marfan Syndrome, arrhythmogenic right ventricular cardiomyopathy, long or short QT Syndrome, Brugada Syndrome, or catecholaminergic polymorphic ventricular tachycardia? *
Required
In the last year, has anyone in your immediate family been diagnosed with Marfan Syndrome, arrhythmogenic right ventricular cardiomyopathy, long or short QT Syndrome, Brugada Syndrome, or catecholaminergic polymorphic ventricular tachycardia? *
Required
In the last year, has anyone in your immediate family under age 50 had a heart problem, pacemaker, or implanted defibrillator? *
Required
MEDICAL RISK QUESTIONS IN THE LAST YEAR
Have you had infectious mononucleosis (mono) within the last month? *
Required
In the last year, have you had a head injury or concussion that still has symptoms like continuing headaches, concentration problems or memory problems? *
Required
In the last year, have you had numbness, tingling, weakness in, or inability to move your arms or legs after being hit or falling? *
Required
Parents or Legal Guardians: Please note below any health concerns, medications, or allergies that may be important for the coaches or athletic/activities to know.
Your answer
I do not know of any existing physical or additional health reason that would preclude participation in sports. I certify that the answers to the above questions are true and accurate and I approve participation in athletic activities. *
Required
2019-2020 MSHSL Eligibility Brochure
Signature
The student/parent authorizes the release of documents and other pertinent information by the school in order to determine student eligibility. In addition, the student/parent understands and agrees that public information shall include names and pictures of students participating in or attending extra-curricular activities, school events, and High School League activities or events.

I/we acknowledge the electronic signature confirms that I/we have read and reviewed the information contained in the contents of the Eligibility Brochure and Statement. I/we also acknowledge this electronic signature has the same legal effect, validity, and enforce ability as a signature in a non-electronic form.

By Signing this we acknowledge that we have read the information contained in the 2019-2020 MSHSL Eligibility Brochure and Statement. *
Required
Student's Signature *
Your answer
Parent's Signature *
Your answer
Email Address
If we have a question regarding your MSHSL Eligibility Form, what email address should we use to contact you?
Your answer
Submit
Never submit passwords through Google Forms.
This form was created inside of Kimball ISD #739. Report Abuse - Terms of Service