2018-2019 Wayne Memorial Athletic Registration
The following form must be completed before a student will be allowed to practice or tryout for any athletic team at Wayne Memorial High School. Failure to fully complete this form will result in delays in the student's opportunity to participate in their sport. The student must also turn in a sports physical form dated after April 15, 2018 before he/she will be allowed to participate.
Please enter student's legal FIRST NAME* *
Your answer
Please enter student's legal LAST NAME* *
Your answer
Please enter student's school ID number *
Your answer
Please select the grade the student will be in during the 2018-19 school year *
FALL SEASON *
Please indicate the sport the student intends to participate in during the FALL SEASON
WINTER SEASON *
Please indicate the sport the student intends to participate in during the WINTER SEASON
SPRING SEASON *
Please indicate the sport the student intends to participate in during the SPRING SEASON
Emergency Contact Person *
Please provide the full name of an emergency contact person (other than parent/guardian) we may call in the event of an injury or illness
Your answer
Emergency Contact Person Phone *
Please provide a valid phone number for the emergency contact person
Your answer
Additional Emergency Contact *
Please enter the name of an additional person who can be contacted in an emergency
Your answer
Additional Emergency Contact Person Phone *
Please provide a valid phone number for the additional emergency contact person
Your answer
Please enter student's gender *
Student Birthdate *
MM
/
DD
/
YYYY
Student's Address *
Your answer
Student's City *
Your answer
Student's Zip Code *
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Student Home Phone Number *
Your answer
Student Cell Phone number *
Your answer
Student Email *
Your answer
Parent/Guardian Name *
Please provide the first and last name of one parent/guardian of the student athlete
Your answer
Parent Phone Number *
Please provide a valid phone number for the parent/guardian listed.
Your answer
Parent Email *
Please provide an email address for the parent/guardian listed in the previous question.
Your answer
Did the student attend Wayne Memorial for the entire 2017-18 school year? *
Incoming freshmen do not need to answer this question
If you answered No to the previous question, please list the school the student attended in 2017-18
Incoming freshman do not need to answer this question.
Your answer
Medical History
Please list any previous injuries, allergies, etc that may affect the student's performance
Your answer
Parent/Guardian or 18 Year Old Student Approval Electronic Signature *
I hereby give my consent for my son/daughter to engage in interscholastic athletics and to accompany the team to away contests in all MHSAA approved sports during the current school year. My consent for my daughter/son to engage in interscholastic athletics is given with my complete knowledge and understanding that the possibility of serious personal injuries associated with participation exists. I accept full responsibility for any injuries which might occur to my son/daughter by reason of participation including, but not limited to, medical bills which may arise in excess of any insurance coverage. In addition, I give my permission and consent to have an athletic trainer (made available to Wayne Westland Community Schools and an entity providing athletic trainer services) to provide services to my son/daughter for sports related injuries. I further agree to authorize the release of my son/daughter's health information (derived from and in connection with treatment between and among the athletic trainers between and among athletic trainers and WWCS' athletic department). I acknowledge the Board of Education for Wayne Westland Community Schools or any person associated with the WWCS' athletic department are not liable under the law and will not assume any responsibility of liability relative to doctor, ambulance, or medical expense. I give my permission for immediate medical attention by a physician when in attendance at the athletic contest. My child does not have any known physical defect, disease, or condition which might prevent him/her from athletic participation. I realize my child will be held responsible for all athletic equipment issued. Further, I will help the coach carry out his/her program by seeing that my child adheres to all training rules and regulations. I understand by entering my name on the line below that this constitutes my legal signature for this document.
Your answer
Physical Form Student Acknowledgement *
I understand that I must have a sports physical performed after April 15, 2018 and that the physical form must be turned in to the athletic department before I will be allowed to tryout or practice with any team at Wayne Memorial High School (http://wwcsd.net/assets/pdfs/athletics/medical-athlete.pdf). I understand my name on the line below constitutes my legal signature for this document.
Your answer
Physical Form Parent Acknowlegement *
I understand that my son/daughter must have a sports physical performed after April 15, 2018 and that the physical form must be turned in to the athletic department before he/she will be allowed to tryout or practice with any team at Wayne Memorial High School (http://wwcsd.net/assets/pdfs/athletics/medical-athlete.pdf). I understand my name on the line below constitutes my legal signature for this document.
Your answer
Concussion Form Student Acknowledgement *
By entering my name on the line below, I certify that I have read the concussion education information and understand that concussions may happen in sport. (http://wwcsd.net/assets/pdfs/parentinfo/parentandathleteinfosheet.pdf). I understand my son/daughter will be required to be seen by a doctor and follow all return to play protocols if he/she has been diagnosed with a concussion.
Your answer
Student Athlete Responsibilities Student Acknowledgement *
By entering my name on the line below, I certify that I have read the Wayne Westland Schools Responsibilities of the Student Athlete (http://wwcsd.net/assets/pdfs/athletics/medical-athlete.pdf) and agree to abide by its policies and expectations.
Your answer
Student Athlete Responsibilities Parent Acknowledgement *
By entering my name on the line below, I certify that I have read the Wayne Westland Schools Responsibilities of the Student Athlete (http://wwcsd.net/assets/pdfs/athletics/medical-athlete.pdf) and agree to abide by its policies and expectations.
Your answer
Student Name and Photo Acknowledgement *
By entering my name on the line below, I certify that I understand my name and/or picture may appear on rosters, game programs, game films, or WWCS websites, which are intended for the advancement of the Wayne Memorial Athletic Department.
Your answer
Parent Name and Photo Acknowledgement *
By entering my name on the line below, I certify that I understand my son or daughter's name and/or picture may appear on rosters, game programs, game films, or WWCS websites, which are intended for the advancement of the Wayne Memorial Athletic Department.
Your answer
Athletic Handbook Student Acknowledgement *
By entering my name on the line below, I certify that I have read the Wayne Westland Schools Athletic Handbook (http://wwcsd.net/assets/pdfs/athletics/athletic-handbook-13-14.pdf) and understand my son/daughter will be expected to abide by its policies and expectations.
Your answer
Athletic Handbook Parent Acknowledgement *
By entering my name on the line below, I certify that I have read the Wayne Westland Schools Athletic Handbook (http://wwcsd.net/assets/pdfs/athletics/athletic-handbook-13-14.pdf) and understand my son/daughter will be expected to abide by its policies and expectations.
Your answer
Thinking About College Athletics?
What is the NCAA Eligibility Center? Why is it Important? The Eligibility Center certifies the academic and amateur credentials of all students who want to play sports at an NCAA Division I or II institution as freshmen. In order to practice, play and receive an athletics scholarship, students need to meet certain academic benchmarks. An additional certification process exists to make sure the student is still an amateur, which is necessary in order for the student to compete. Students must register at www.eligibilitycenter.org. Path to the Student-Athlete Experience: If student athletes wish to participate in NCAA Division I or II athletics, they need to be certified by the NCAA Eligibility Center. Students need to qualify academically and will also need to be cleared as an amateur student-athlete. Students are responsible for achieving and protecting their eligibility status! Check with your high school counselor to make sure you are on track to graduate on time with your class and have the required amount of core courses. Ask your high school counselor to submit your final transcript with proof of graduation. http://fs.ncaa.org/Docs/eligibility_center/Quick_Reference_Sheet.pdf
Your answer
NCAA Information Student Acknowledgement
By entering my name on the line below, I certify that I have read the NCAA Eligibility information and understand that it is my responsibility to ensure that I have the proper credentials to participate in NCAA athletics.
Your answer
NCAA Information Parent Acknowledgement
By entering my name on the line below, I certify that I have read the NCAA Eligibility information and understand that it is my responsibility to ensure that my child has the proper credentials to participate in NCAA athletics.
Your answer
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