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MCI Athletics Agreement & Permissions
All MCI student-athletes must obtain permission to participate in athletics from their parent(s)/guardian(s). This form must be completed BEFORE an MCI student-athlete is allowed to participate during each school year. This form covers athletic participation, permission to treat injuries by MCI medical staff; and permission to publish names and photos on MCI affiliated media.
Email address *
Last name of student-athlete: *
Your answer
First name of student-athlete: *
Your answer
Year of graduation: *
Your answer
PARENT/GUARDIAN - TRAINING, ELIGIBILITY & RISK AGREEMENT
I/We have read and understand the MCI Athletic Handbook (copy may be referenced or downloaded from the Athletics Home page at www.mci-school.org). My student-athlete has read, and understands, the MCI Athletic Handbook. We are clear on the commitment required for participation in MCI Interscholastic Athletics and the policies that govern the student-athlete's eligibility to participate. We understand that participation in athletic activities and the travel involved with being on a team constitutes a risk of injury and will not hold Maine Central Institute or any employee of MCI responsible should an injury occur. We hereby give our student/athlete permission to participate in MCI Interscholastic Athletics. *
MAINE CENTRAL INSTITUTE PERMISSION TO TREAT FORM 2018-19
** If changes occur in regard to your child’s health information (change of address, guardianship, physician, insurance providers, etc.) please update these changes in your child’s MCI Powerschool account immediately to allow MCI to best serve the well being of your child.
I certify that I am the parent/legal guardian of the above named student-athlete. My signature below indicates that I have registered/updated my child's emergency contact, insurance, and medical information in the MCI Powerschool database. I also attest that the information entered is complete, current and accurate. Electronic signature required below. *
Your answer
Permission to treat: I, parent/guardian of the above named student-athlete, certify that I have valid accident insurance coverage in force that will cover my child should an accident occur. Furthermore in the event of illness or accident involving my child, I hereby give permission to Maine Central Institute, its officials, and the athletic trainers, nurses, physicians, surgeons, and dentists retained by the School, to secure and furnish medical, dental or surgical care and treatment for him/her and to give, administer and render any treatment or aid including necessary immunizations, anesthetics, or surgery, as necessary to protect, preserve, and safeguard the life and/or health of my child for the current school year. Electronic signature required below. *
Your answer
Release of Information: I hereby give permission to Maine Central Institute, its officials, including the athletics staff and the athletic trainers, nurses, physicians, surgeons, and dentists retained by the School to release, disseminate and provide health information concerning my child’s medical status, medical conditions, injuries, prognosis, diagnosis, and related personally identifiable health information to athletic training students and coaches. This information includes injuries or illnesses relevant to past, present, or future participation in athletics at Maine Central Institute. Electronic signature required below. *
Your answer
PERMISSION TO PUBLISH
If you have any questions concerning this form, please contact Pam Dorman, Director of Communications
at (207) 487-5915.
Maine Central Institute has my permission to publish photographs/videos of my child and to identify my child by name on the MCI website and social media, in school publications, or in the local media (i.e. newspapers) for the purpose of promoting school news, activities, and achievements. *
STUDENT TRAINING & ELIGIBILITY AGREEMENT
I have read, understand and will abide by the training and eligibility rules set forth by Maine Central Institute. Student-athlete's electronic signature required below. *
Your answer
Please list all the sports you plan to participate in at MCI this year.
Your answer
A copy of your responses will be emailed to the address you provided.
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