Batavia High School-Department of Athletics- Registration 2019-20
PARENT & ATHLETE CONSENT FORM 2019-2020
Completion and submission of this form assumes consent to all Batavia High School
Athletic Department required forms and documents. These documents are available on the athletics registration webpage.

IMPORTANT: IN ADDITION TO COMPLETING THIS REGISTRATION PAGE
YOU MUST ALSO PAY THE PARTICIPATION FEE & PROVIDE BHS WITH A CURRENT IHSA PHYSICAL.

PAYING THE FEE THROUGH POWERSCHOOL DOES NOT REGISTER YOUR CHILD FOR ATHLETICS.

THIS FORM MUST BE COMPLETED AND SUBMITTED IN ADDITION TO FEE PAYMENT & SCHOOL REGISTRATION.

Please review all documents carefully before submitting this form.
Student-Athlete Name *
FORMAT: Last Name, First Name EXAMPLE: Smith, David
Your answer
Student-Athlete Gender *
Select Below
Home Address *
FORMAT: Street, City, Zipcode
Your answer
Home Phone (or Primary Phone) *
FORMAT: XXX-XXX-XXXX
Your answer
Athlete's Date of Birth *
MM
/
DD
/
YYYY
Student's Year in School 2019-20 *
select from list below
BHS FALL Sports Athlete is Planning on Participating in 2019-20
Check all that apply
BHS WINTER Sports Athlete is Planning on Participating in 2019-20
Check all that apply. (Note: Track in Field Season Feb through Late May)
BHS SPRING Sports Athlete is Planning on Participating in 2019-20
Check all that apply
Parent Contact Information
If options do not apply please type N/A in box.
Mother Name *
FORMAT: Last Name, First Name EXAMPLE Smith, Mary
Your answer
Mother's Cell Phone *
FORMAT: XXX-XXX-XXXX
Your answer
Mother's Email *
Please enter only one email address/best address to reach Mother
Your answer
Father's Name *
FORMAT: Last Name, First Name EXAMPLE Smith, Mary
Your answer
Father's Cell Phone *
FORMAT: XXX-XXX-XXXX
Your answer
Father's Email *
Please enter only one email address/best address to reach Father
Your answer
Emergency Contact Information and Treatment Authorization
In the event a Parent/Guardian can not be reached.
Emergency Contact Name *
FORMAT: Last Name, First Name EXAMPLE: Jones, David
Your answer
Emergency Contact Cell Phone *
FORMAT: XXX-XXX-XXXX
Your answer
Emergency Medical Treatment Authorization *
If I cannot be reached and if in the judgment of school personnel immediate medical attention is required, I authorize responsible school and/or medical personnel to send my child to an available doctor/hospital.
Pre-Existing Condition
Does the student-athlete have a pre-existing medical condition that the Athletic Trainer, Head Coach & Athletic Department need to be made aware of?
Your answer
Parent & Athlete acknowledgement and consent
Please verify that you and your student-athlete have read and discussed
these documents:

1. PARENT/ATHLETE: Consent to Batavia High School Code of Conduct for Extra-Curricular Performance Based Activities
LINK: https://www.bps101.net/bps101-student-handbook/code-of-conduct/

2. PARENT/ATHLETE: IHSA Sports Medicine Acknowledgement & Consent Form
includes: concussion information, performance enhancing drug information and asthma medication consent.
LINK: https://goo.gl/KRVyaN

3. PARENT/ATHLETE: We have viewed the IHSA Concussion video
LINK: https://www.ihsa.org/multimedia/articulate/concussion/presentation.html

4. PARENT/ATHLETE: We have viewed the Batavia High School Athletic Department Registration Video
LINK: https://goo.gl/a4wxd8
PARENT: Acknowledgement & Consent *
I (Parent) have reviewed the above documents and video.
Required
ATHLETE: Acknowledgement & Consent *
I (Student) have reviewed the above documents and video.
Required
PARENT: Parent Consent to Allow Child to Participate in Athletics at Batavia High School *
I have accurately completed this registration form, consented to all required documents, and understand the Illinois High School Association and Batavia School District rules and regulations regarding athletic eligibility and participation. I give my child permission to participate in the above selected sports. PARENT: PLEASE TYPE YOUR FULL NAME BELOW TO GIVE CONSENT
Your answer
Date Consent Form Completed *
Please record the date you are submitting this completed document
MM
/
DD
/
YYYY
Submit
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