Ridgeview Middle School
Welcome to the 2018-2019 Ridgeview Intramural Sports Program, which gives students a great opportunity to socialize, exercise, and capitalize on a physical structured activity program! Intramural sports are open to 6th, 7th, and 8th grader’s. 6th Graders are not eligible for Middle School Sports Teams, but they are encouraged to do intramural sports. There are no tryouts. A willingness to engage in fair competition is the only requirement.

⚽ Intramural Soccer ⚽ - Mr. DiMarco - Wednesdays - Staring 10/3 - RM 202

📣 Intramural Cheerleading 📢 - Cynthia Thomas - Wednesdays - Starting 10/10 - GYM/Cafe’

🏈 TBD 🏈 - TBD - TBD - TBD - TBD

🏀 Intramural ⚽ Multi-Sports 👟 - Alan Nelson - Tuesday - Starting 9/25 - 202

Mandatory Paperwork
🔳 Parent/Guardian Permission Form or eForm
🔳 Medical Card For Athlete
🔳 Turn in completed forms to Main Office for Mr. Nelson’s Mailbox
🔳 You may eMail Alan_D_Nelson@mcpsmd.org for electronic forms
Email address *
You will be providing the information below electronically to grant permission for your student to participate in intramural sports. The image below is last years example. (Scroll down)
First *
Student's first name as it appears in MCPS records. No nicknames.
Your answer
Middle *
Student middle initial or names as it appears in MCPS records.
Your answer
Last *
Student's last name(s) as it appears in MCPS records.
Your answer
Grade *
Transportation *
I have indicated below the manner in which my child will be transported home. You may select more than one option.
Required
Activity *
I have indicated below the intramural activities my child may participate. You may select more than one option.
Required
Comment
Additional comment to activity sponsor.
Your answer
Parent/Guardian *
Please enter your full name as parent or guardian of the above student. By entering your name you acknowledge your permission for you student's participation in Ridgeview Middle School Intramural Sports.
Your answer
You will be providing the information for the "Medical Card For Athlete" below electronically for your student to participate in intramural sports. (Scroll down)
DOB *
Birth Date (Month, day, year)
MM
/
DD
/
YYYY
Student ID *
Enter your students ID number.
Your answer
Address1 *
1st street address line.
Your answer
Address2
2nd street address line.
Your answer
City *
Your answer
State *
Your answer
ZipCode *
Your answer
Home *
Parent/Guardian home phone number who granted student permission above. (If you do not have this type of number, re-enter another contact number)
Your answer
Work *
Parent/Guardian work phone number who granted student permission above. (If you do not have this type of number, re-enter another contact number)
Your answer
Cell *
Parent/Guardian cell phone number who granted student permission above. (If you do not have this type of number, re-enter another contact number)
Your answer
Parent/Guardian2
Please enter the full name of a second parent or guardian of the above student. This entry is optional but highly encouraged.
Your answer
Home2
Parent/Guardian2 home phone number of the student above. (This entry is optional but highly encouraged.)
Your answer
Work2
Parent/Guardian2 work phone number of the student above. (This entry is optional but highly encouraged.)
Your answer
Cell2
Parent/Guardian2 cell phone number of the student above. (This entry is optional but highly encouraged.)
Your answer
Emergency Contact *
Please enter the full name of an Emergency Contact of the above student.
Your answer
Relationship *
Emergency contact relationship to student. (Grandparent, family friend, etc.)
Your answer
HomeEC
Emergency contact home phone number for the student above. (This entry is optional but highly encouraged.)
Your answer
WorkEC
Emergency contact work phone number for the student above. (This entry is optional but highly encouraged.)
Your answer
CellEC *
Emergency contact cell phone number for the student above. If the emergency contact has only one phone number, please enter it here.
Your answer
Physician
Name of your students family physician.
Your answer
Physician Number
Physician's phone number.
Your answer
Hospital Preference
Your answer
Tetanus
Date of last tetanus shot.
MM
/
DD
/
YYYY
Allergies *
List allergies separated by commas. If no allergies enter "none".
Your answer
Self-Carry *
Indicate if student self-carries epinephrine auto injector. If “Yes”, the MCPS Form 525-14 link above must be completed and submitted.
Insurance *
Does the student have medical insurance?
Insurance Information
If "Yes", please enter insurance company name.
Your answer
RELEASE FOR TREATMENT
I hereby give permission to the attending physician or hospital to administer appropriate medical treatment in the event I cannot be reached.
Parent/Guardian/Eligible Student *
Enter full name.
Your answer
A copy of your responses will be emailed to the address you provided.
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