Hill Athletic Participation Agreement
2019 Girls Soccer Season - Parents/guardians complete a form for each athlete participating in athletics at Hill Middle School. Please provide a PARENT email address below to receive a confirmation of completion and a copy of our athletic code of conduct, concussion waiver, and our school policies that all athletes must follow for the duration of the season.
Email address *
2019 Girls Soccer
First Name (Student) *
Your answer
Last Name (Student) *
Your answer
Grade *
Gender *
Street Address *
Your answer
City/ZIP *
Your answer
Parent/Guardian Full Name *
Your answer
Parent/Guardian Cell Phone *
Your answer
Optional 2nd Cell Phone
Your answer
Emergency Contact *
Your answer
Emergency Contact Phone *
Your answer
Required Electronic Documents
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
Hill Middle School Athletic Code of Conduct *
Parent/Guardian and athletes are asked to and read the following guidelines and submit an electronic commitment to your school, administrators, and coaches. In doing so, you are acknowledging that you have read and will comply with these guidelines and policies. Click on the link to view the athletic code of conduct: https://goo.gl/fH92n4
Concussion From Acknowledgment *
Click the follow link for the district concussion policy and read through the material. In doing so, you are acknowledging that you have read and will comply with these guidelines and policies. https://goo.gl/s81CRj
Additional Statements
I understand that I am responsible for transportation home from school at 5:00 P.M. *
Please note that daily practice ends at 4:55 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 by 5:00, athletes should not attend practice that day.
Athletic Fees ($125.00 per sport)
Athletes are asked to pay a $125.00 fee per sport ($250.00 for two or more). Please do NOT make a payment until your athlete has made team. Complete 1 of the payment options listed below. Athletes that do not make a payment by the first game will not get a team uniform and will not participate in games until a payment has been made.
1. Pay by check (payable to Wheatland Athletic Association with your phone number and the student's ID#)
2. Pay with cash
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
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Indian Prairie School District. Report Abuse - Terms of Service