UNIS ATHLETICS
United Nations International School
Winter Season 2018-19
Student's First Name *
Your answer
Student's Last Name *
Your answer
Student's UNIS Email *
Your answer
Grade *
Student's ID number *
Your answer
DESCRIPTION OF THE PROGRAM
Varsity athletic programs afford opportunities to those athletes who exhibit the greatest skills in their chosen sport.

Junior Varsity athletic programs afford those students who do not yet possess the skills required of varsity athletes an opportunity to participate in a competitive setting, but are in the process of gaining the valuable knowledge, skill and experience required for varsity competition.

Middle School athletic programs are designed to provide 7th and 8th grade (M3 & M4 students) with the opportunity to participate in an instructional yet competitive setting.

Which team is your child participating/trying out for this season? *
Parent/Guardian 1 *
Your answer
Email *
Your answer
Primary phone number *
Your answer
Parent/Guardian 2
Your answer
Email
Your answer
Primary phone number
Your answer
EMERGENCY CONTACTS (if parent(s)/guardian cannot be reached) *
Your answer
Relationship to student *
Your answer
Emergency Phone *
Your answer
Annual Physical Form
It is a UNIS requirement that a student must have an annual physical form on file. A physical exam is only valid for one calendar year. Student-athletes may not participate in athletics without a current physical. Please provide the date of most recent physical completed by your child's M.D ( If unsure please consult the parent portal- specifically the Magnus health forms) *
Your answer
Consent to Treat: Please read the attatched document and initial below that you the parent have read and understand statement. http://bit.do/UNISCTT *
Your answer
*Students in Grades 7-12 who have been prescribed an inhaler or epi-pen are required to carry such medications with them at all times during school activities. INITIAL BELOW TO CONFIRM YOU UNDERSTAND THIS STATEMENT. *
Your answer
Health History Update
Please read the attatched document before completing the following questionnaire. Initial below that you, the parent/caregiver, have read and understood the statement. http://bit.do/UNISHHU *
Your answer
Does your son/daughter have any additional medical concerns/needs that we should be aware of?* *
If yes, please provide a description.
Your answer
Any injuries requiring medical attention? *
If yes, please provide a description.
Your answer
Head injury or concussion? *
If yes, please provide a description.
Your answer
Any illness lasting more than 5 days *
If yes, please provide a description
Your answer
Is he/she taking medicine or under a physician's care at this time? *
If yes, please provide a description.
Your answer
Change in vision regarding glasses or contact lenses? *
If yes, please provide a description.
Your answer
Headaches? *
If yes, please provide a description.
Your answer
Asthma with an inhaler prescribed? *
Has an epi-pen been prescribed? *
Any allergies? *
If yes, please provide a description.
Your answer
Any treatment in a hospital or emergency room? *
If yes, please provide a description.
Your answer
Any chronic diseases? *
If yes, please provide a description.
Your answer
Change in nutritional habits? *
If yes, please provide a description.
Your answer
Change in activity/exercise program? *
If yes, please provide a description.
Your answer
Specifically during or after exercise, has the student experienced any one or more of the following symptoms: *
Required
If you have selected any of the above symptoms please provide further information.
Your answer
Health History Consent
I, the undersigned, clearly understand that these questions are asked to determine if a student can safely participate on the team listed at the top of this form. The answers are correct as of this date and my son/daughter has permission to participate. The most current emergency contact information has been provided to the athletics department on a separate form. INITIAL BELOW TO CONFIRM YOU UNDERSTAND THIS STATEMENT. *
Your answer
Athletic Travel and Dismissal Consent
This form indicates your directive for your son/daughter’s dismissal from athletic events during the 2018–2019 school year. Any deviation from this directive, including permission for your son/daughter to leave with another parent, must be made in writing. All UNIS teams travel to and from games and practices via chartered bus, or on foot. Students are not allowed to drive to and from any athletic events. Athletes in grades 7-12 will return to UNIS by the same mode of transportation, unless given permission for alternate means, as indicated below. I GIVE PERMISSION FOR MY SON/DAUGHTER TO: (PLEASE CHECK ALL THAT APPLY) *
Required
Concussion Procedures
Concussion Management Statement: http://bit.do/UNISCMS Concussion Management Protocol: http://bit.do/UNISCMP NYSPHSAA Concussion Student and Parent Information Sheet: http://bit.do/NYSPHSAA Initial below that you the parent have read and understood the statement. *
Your answer
Subject to my child's successful selection to a team, I agree to a charge of $200.00 to cover transportation and administrative costs. (This fee will be billed to student accounts following the winter season) *
Required
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