RICHMOND HILL MIDDLE SCHOOL
ATHLETE REGISTRATION FORM FOR 2018-2019

This registration information must be completed by the child's parent/guardian. If it is determined that someone other than the parent/guardian completed the registration, the child will not be allowed to participate in RHMS athletics.

Students must have a physical form completed by a doctor on file in order to participate at RHMS.

STUDENT ATHLETE INFORMATION
ATHLETE'S BIRTHDATE:
MM
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DD
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ATHLETE'S LAST NAME *
Your answer
ATHLETE'S FIRST NAME *
Your answer
ATHLETE'S AGE *
Your answer
2018-2019 STUDENT GRADE LEVEL *
Which sport(s) are you registering for? *
Required
PARENT/GUARDIAN INFORMATION
Please complete the following information.
PARENT/GUARDIAN #1
Use N/A when not applicable.
NAME (1) *
Please enter first and last name.
Your answer
STREET/MAILING ADDRESS (1) *
Your answer
HOME PHONE NUMBER (1) *
Your answer
CELL NUMBER (1) *
Your answer
WORK PHONE NUMBER (1) *
Your answer
EMAIL ADDRESS (1) *
Your answer
PARENT/GUARDIAN #2
Use N/A when not applicable.
NAME (2) *
Please enter first and last name.
Your answer
STREET/MAILING ADDRESS (2) *
Your answer
HOME PHONE NUMBER (2) *
Your answer
CELL NUMBER (2) *
Your answer
WORK PHONE NUMBER (2) *
Your answer
EMAIL ADDRESS (2) *
Your answer
Emergency Information
Please enter the following information for someone other than an immediate family member.
EMERGENCY CONTACT NAME *
Your answer
EMERGENCY CONTACT PHONE NUMBER *
Your answer
EMERGENCY CONTACT RELATIONSHIP *
Your answer
PHYSICIAN'S NAME *
Your answer
PHYSICIAN'S TELEPHONE NUMBER *
Your answer
PRIMARY INSURANCE COMPANY *
If you do not have insurance, please go to http://markel.sevencorners.com/ and purchase accidental insurance for your child. Your child will not be allow to participate until they are insured.
Your answer
PRIMARY INSURANCE COMPANY PHONE # *
Your answer
NAME OF POLICY HOLDER *
Your answer
POLICY AND GROUP NUMBER *
Your answer
STUDENT ATHLETE AND PARENT CONTRACT
Middle School officials, coaches of athletic teams and sponsors of student activities believe that students who are selected for the privilege of membership on teams, squads, performing groups, clubs, and other school organizations should conduct themselves as responsible representatives of the school. Furthermore, members of teams and organizations who fail to abide by the Student Athlete’s Contract are subject to disciplinary action. Members of teams and organizations must always serve as an exemplary model of high moral character and must demonstrate appropriate academic commitment, which is expected from all students.

ATTENDANCE:
1. All team members of each sport are expected to attend all scheduled practices and meetings. This includes practices that are scheduled on holidays and during Fall and Spring Breaks. Furthermore, athletes are expected to attend practices and games for the entire scheduled time. Athletes will not be allowed to leave practices and games early to attend other practices and games. RHMS athletics should be your top priority.

2. A player who misses practice due to illness must have a note from his/her parent after the first absence. All other absences require a doctor’s note.

3. If circumstances arise whereby the student cannot attend practice or a meeting, the coach must be notified prior to the practice or meeting by personal contact, phone call, or written statement from the parent or guardian.

4. If an athlete is absent from practice the day preceding competition, he/she will not be allowed to participate in that game.

5. If an athlete is absent from school, he/she is not allowed to practice that day.

6. If an athlete is absent on the day of a game, he/she will not be allowed to play in that game.

7. Excessive absences from team practices, games or meetings may be cause for removal from that sport.

ELIGIBILITY:
1. A student may not participate if he/she turns 14 years of age prior to May 1st of his/her sixth grade year, 15 years of age prior to May 1st his/her 7th grade year, or 16 years of age prior to May 1st during his/her 8th grade year. Any student for which this rule applies is ineligible for athletic participation for the entire school year.

2. A player is eligible for one year in the sixth grade, one year in the seventh grade and one year in the eighth grade, providing they meet the age requirement.

3. Players may not fail more than 2 classes per semester. If a student is retained, he/she is not eligible for sports at any time during the school year.

4. Players must register online and provided insurance information and a valid physical exam on a Bryan County School form.

5. Eighth grade students may not play at the high school level unless RHMS does not offer a particular sport, RHHS does offer that particular sport, and they welcome eighth grade participants.

UNIFORMS, EQUIPMENT AND FEES:
1. Each athlete is responsible for each item of equipment issued to him or her.

2. Lost or stolen equipment must be paid for by the athlete at the replacement cost.

3. An athlete will not be allowed to participate in the next season sport or will not be allowed to receive his or her awards and/or grades until the equipment has been returned or paid for.

4. Team uniforms are not to be used for any purpose other than representing RHMS in athletic contests. Uniforms may be worn to school on certain days, as specified by the coach or administration.

TRANSPORTATION:
1. All athletes must travel to athletic contests with the coach. School buses will be used for the trips. IF AN ATHLETE FAILS TO RIDE THE BUS TO AN OUT OF TOWN GAME OR ACTIVITY, HE/SHE WILL NOT BE ALLOWED TO PARTICIPATE DURING THAT SCHEDULED CONTEST.

2. Athletes will not be allowed to ride home with someone other than their parents unless written permission is given by the parents prior to the athletes leaving the school for the athletic event. Coaches may not obtain permission over the phone!

3. Each athlete must also be signed out prior to their departure from the out of town game.

4. It is the athlete’s responsibility to schedule a ride home after every practice and game. For out of town games, the athlete should have a ride home waiting at the school when the bus arrives.

5. If an athlete is repeatedly late being picked up from practice or games, the coach has the right to remove the player from the team.

MISCELLANEOUS:
1. Athletes are not allowed to practice or play while they are serving OSS. Coaches have the right not not allow players to play or practice while serving ISS.

2. Each coach or sponsor has the prerogative to establish additional rules pertaining to the activity supervised. These rules may include attendance at practices, contests, etc. Rules set by the individual coach or sponsor must be in writing and approved by the Athletic Director and communicated to the participants before the activity begins.

4. Any student who violates the guidelines and/or does not satisfactorily complete the season or activity may not be eligible for any awards or special recognition given for participation in the sport. Furthermore, a student who holds an elected or appointed position (i.e., peer leader, team captain, student organization officer) may be required to relinquish said position upon violation of the Student Athlete Contract.

5. Chain of Communication: If problems arise during the season, the protocol listed below should be followed to resolve the situation.
a. Contact the Head Coach – Please do not approach the coach to discuss the playing time of your child. This is the coach’s decision and will not be discussed. Any other items should be discussed by contacting the coach via email, telephone, or scheduling a conference. Coaches will not talk with parents after a game or practice.
b. Contact the Athletic Director – If you are unable to resolve your issue with the head coach, contact the athletic director via email, telephone, or scheduling a conference. At this point, the athletic director will determine if another meeting with the coach, player, and parents will need to be scheduled. If so, the meeting will take place and require all parties to be in attendance.
c. Contact the Principal – If resolution is still not reached, contact the principal by telephone or schedule a conference.
d. Contact the Superintendent – If resolution is not reached at the school level, the parents should contact the Superintendent.

I understand that if I or my child do not keep our agreement to fulfill the obligations of the Student Athlete and Parent Contract, my child will be removed from athletics. *
Required
PERMISSION AND MEDICAL RELEASE
I am aware playing or practicing in any sport or sport related activity could be a dangerous activity involving MANY RISKS OF INJURY. I understand that the dangers and risks of playing or practicing in sports or sport related activity include, but are not limited to: death; serious neck and spinal injuries that may result in complete or partial paralysis; brain damage; serious injury to virtually all bones, joints, ligaments, muscles, tendons, other aspects of the musculoskeletal system and vital organs; and serious impairment to other aspects of the body, general health, and well-being. I understand the dangers and risks of playing or practicing in any sport or sport related activity may result not only in serious injury, but in a serious impairment of the participant’s future abilities to earn a living; to engage in other business, social, and recreational activities; and generally enjoy life because of the dangers of playing or practicing in any sport or sport related techniques and training.

I specifically acknowledge that Football is a collision sport that involves an even greater risk of injury than contact sports: Basketball, Baseball, Cheerleading, Soccer, Softball, and Wrestling which involve greater risk of injury than non-contact sports: Cross Country,Track and Field, Volleyball, Tennis, and Golf.

As the parent/legal guardian of the above name participant, I have read the above warnings and release, and understand its terms. I hereby agree to hold the Richmond Hill Middle School, its direct and contracted employees, agents, representatives, coaches and volunteers harmless from any and all liability, actions, causes of action, debts, claims, or demands of every kind and nature whatsoever that may arise by or in connection with participation of my child in any activities related to Richmond Hill Middle School activities. The terms hereof will serve as a release for my heirs, estate, executor, administrator, assignees, and for all members of my family.

I give permission for representatives of Richmond Hill Middle School to authorize medical treatment for my child in my absence. This may include, but is not limited to activation of emergency services, transportation to the hospital designated below, emergency room procedures, and injury/illness evaluation and treatment by certified athletic trainers at away competitions.

HOSPITAL DESIGNATION *
Please list the hospital you want your child transported to in case of an emergency.
Your answer
Concussion Awareness
DANGERS OF CONCUSSION
Concussions at all levels of sports have received a great deal of attention and a state law has been passed to address this issue. Adolescent athletes are particularly vulnerable to the effects of concussion. Once considered little more than a minor "ding" to the head, it is now understood that a concussion has the potential to result in death, or changes in brain function (either short-term or long-term). A concussion is a brain injury that results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain, and even death.

Player and parental education in this area is crucial - that is the reason for this document. Refer to it regularly. This form must be electronically signed by a parent or guardian of each student who wishes to participate in GHSA athletics.

COMMON SIGNS AND SYMPTOMS OF CONCUSSION
• Headache, dizziness, poor balance, moves clumsily, reduced energy level/tiredness
• Nausea or vomiting
• Blurred vision, sensitivity to light and sounds
• Fogginess of memory, difficulty concentrating, slowed thought processes, confused about surroundings or game assignments
• Unexplained changes in behavior and personality
• Loss of consciousness (NOTE: This does not occur in all concussion episodes.)

BY-LAW 2.68: GHSA CONCUSSION POLICY: In accordance with Georgia law and national playing rules published by the National Federation of State High School Associations, any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion shall be immediately removed from the practice or contest and shall not return to play until an appropriate health care professional has determined that no concussion has occurred. (NOTE: An appropriate health care professional may include, licensed physician (MD/DO) or another licensed individual under the supervision of a licensed physician, such as a nurse practitioner, physician assistant, or certified athletic trainer who has received training in concussion evaluation and management.
a) No athlete is allowed to return to a game or a practice on the same day that a concussion (a) has been diagnosed, OR (b) cannot be ruled out.
b) Any athlete diagnosed with a concussion shall be cleared medically by an appropriate health care professional prior to resuming participation in any future practice or contest. The formulation of a gradual return to play protocol shall be a part of the medical clearance.
c) It is mandatory that every coach in each GHSA sport participate in a free, online course on concussion management prepared by the NFHS and available at www.nfhslearn.com at least every two years-beginning with the 2013-2014 school year.
d) Each school will be responsible for monitoring the participation of its coaches in the concussion management course, and shall keep a record of those who participate.

Concussion *
I have read this information and understand the facts presented in it.
Heat & Humidity Awareness
GHSA By-Law 2.67 - Practice Policy for Heat and Humidity:
(a) Schools must follow the statewide policy for conducting practices and voluntary conditioning workouts (including during the summer) in all sports during times of extremely high heat and/or humidity that will be signed by each head coach at the beginning of each season and distributed to all players and their parents or guardians. The policy shall follow modified guidelines of the
American College of Sports Medicine in regard to:
(1) The scheduling of practices at various heat/humidity levels
(2) The ratio of workout time to time allotted for rest and hydration at various heat/humidity levels
(3) The heat/humidity levels that will result in practice being terminated
(b) A scientifically-approved instrument that measures the Wet Bulb Globe Temperature must be
utilized at each practice to ensure that the written policy is being followed properly. WBGT readings should be taken every hour, beginning 30 minutes before the beginning of practice.
(c) Practices are defined as: the period of time that a participant engages in a coach-supervised, school-approved sport or conditioning-related activity. Practices are timed from the time the players report to the practice or workout area until players leave that area. If a practice is interrupted for a weather-related reason, the “clock” on that practice will stop and will begin again when the practice resumes.
(d) Conditioning activities include such things as weight training, wind-sprints, timed runs for distance, etc., and may be a part of the practice time or included in “voluntary workouts.”
(e) A walk-through is not a part of the practice time regulation, and may last no longer than one hour. This activity may not include conditioning activities or contact drills. No protective equipment may be worn during a walk-through, and no full-speed drills may be held.
(f) Rest breaks may not be combined with any other type of activity and players must be given unlimited access to hydration. These breaks must be held in a “cool zone” where players are out of direct sunlight.
PENALTIES: Schools violating the heat policy shall be fined a minimum of $500.00 and a maximum of $1,000.00.

WET BULB GLOBE TEMPERATURE (WBGT) ACTIVITY GUIDELINES AND REST BREAK GUIDELINES

• Under 82.0 - Normal Activities - Provide at least three separate rest breaks each hour with a minimum duration of 3 minutes each during the workout.
• 82.0 - 86.9 - Use discretion for intense or prolonged exercise; watch at-risk players carefully. Provide
at least three separate rest breaks each hour with a minimum duration of 4 minutes each.
• 87.0 – 89 - Maximum practice time is 2 hours. For Football: players are restricted to helmet, shoulder
pads, and shorts during practice, and all protective equipment must be removed during
conditioning activities. If the WBGT rises to this level during practice, players may continue
to work out wearing football pants without changing to shorts. For All Sports: Provide at least
four separate rest breaks each hour with a minimum duration of 4 minutes each.
• 90.0 - 92.0 - Maximum practice time is 1 hour. For Football: no protective equipment may be worn during
practice, and there may be no conditioning activities. For All Sports: There must be 20 minutes
of rest breaks distributed throughout the hour of practice.
• Over 92.1 - No outdoor workouts. Delay practice until a cooler WBGT level is reached.

Heat & Humidity *
I have read this information and understand the facts presented in it.
Medication Authorization
Authorization forms may be located on the Athletic Home Page under forms. This form needs to be completed by a physician and submitted prior to participation.
My child needs to carry the following prescription medication and has been instructed in the proper usage and administration of the medication. *
Required
FINAL AUTHORIZATION
I understand that my child is not completely registered until I have turned in a completed physical and academic eligibility has been verified. *
Required
I hereby declare that I am the child's parent/guardian and have completed the registration with accurate information. *
If it is determined that someone other than the parent/guardian has completed this registration, the child will not be allowed to participate in RHMS athletics.
Required
NAME OF PARENT/GUARDIAN COMPLETING REGISTRATION *
This will serve as an electronic signature for registration purposes.
Your answer
DATE REGISTRATION COMPLETED *
MM
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YYYY
Please note that your information will be shared with all RHMS head coaches and game managers. Your information may also be shared with any personnel that is called to assist your child in a time of need. *
Required
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