2018-19 Winter Sports Registration
*This form is to be completed by a parent/guardian for the perspective student-athlete.
Student First Name *
Your answer
Student Last Name *
Your answer
Student ID # *
Your answer
Grade *
2018-19 school year
Sport *
Students are only eligible to participate in 1 sport per season by MIAA rule.
Do you have a current physical on file with the school? *
Physicals are considered current/valid for 13 months by MIAA rule.
Concussions: Students and Parent Information *
Parents and students – athletes who plan to participate in any Greater Lowell Technical High School athletic program must complete a free on-line concussion course. Two free on-line courses are available and contain all information required by law. The entire course, including registration, can be completed in less than 30 minutes. Below are the links for the two programs available. Please note that completion of only ONE (1) of the two is required. http://www.nfhslearn.com/electivedetail.aspx?courseID=15000 http://www.cdc.gov/Concussion My student-athlete and I have taken the online course regarding head injuries. It can be found atwww.cdc.gov/concussion/HeadsUp/online_training.html. Or www.nfhslearn.com/electiveDetail.aspx?courseID=38000 I am aware of the recent changes/updates to the head injury legislation. Greater Lowell Tech uses return to play protocol in situations where head injury is concerned.
Required
Concussion History *
Has student been previously diagnosed with a concussion?
Past Concussion Information
If you answered yes to the previous question, please provide date below.
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Info on Substance Use Disorder Prevention *
Recent Massachusetts legislation requires that parents, guardians and students in 6th-12th grade receive educational materials on the dangers of opioid use and misuse. The educational information must be distributed to students involved in an extracurricular athletic activity prior to the beginning of their athletic seasons. The Massachusetts Department of Health with the Massachusetts Interscholastic Athletic Association (MIAA) and Massachusetts Technical Assistance Partnership for Prevention (MassTAPP) have developed a set of four fact sheets for the extracurricular school sports community on prescription opioid misuse prevention entitled: What to Know About Prescription Opioids, Preventing Prescription Opioid Misuse Among Athletes, Guidance on Communication After Opioid Non-Sports Injury, and Injury Management Opioid Misuse Prevention. Links for each of these can be found at; http://www.mass.gov/eohhs/gov/departments/dph/programs/community-health/dvip/injury-prevention/substance-use-disorder.html My student-athlete and I have reviewed this info prior to the start of the athletic season.
Required
Parent/Guardian Name *
Your answer
Parent/Guardian Contact *
Please provide the BEST number to reach you in case of emergency.
Your answer
2nd Parent/Guardian Name
Your answer
2nd Parent/Guardian Contact
Please provide the BEST number to reach you in case of emergency.
Your answer
Alternative Contact Name *
Please provide an alternative contact in the event a parent/guardian can not be reached in the event of an emergency.
Your answer
Alternative Contact Phone *
Your answer
Medical Conditions *
Does your son/daughter have any medical conditions, allergies, or take any medications the his/her advisor/coach should be aware of?
Medical Conditions Explained
If you answered yes to the previous question, please explain.
Your answer
Signature of GL Tech Parent/Guardian Consent *
I HAVE READ, UNDERSTAND AND AGREE TO 1. Student Eligibility Requirements. 2. Loyalty to the high school team and non-school team competition rule as well as Hazing Law, Chapter 536 3. The MIAA Chemical Health Policy as well as all MIAA general rules and academic eligibility. 4. Athletes are responsible for all issued equipment. Lost or stolen equipment will be paid for by the athlete that is missing the equipment at the conclusion of the season. 5. I understand that pictures of my son/daughter may be posted on athletic websites, in school promotional materials, featured in local news publications, as well as broadcast on local media outlets. 6. The Greater Lowell Technical High School is not responsible for any medical or hospital charges incurred resulting from my child’s participation in athletic programs. 7. Charges will be billed to my family’s medical insurance or directly to parents/guardians by the medical service provider. 8. I do hereby consent to my child’s participation in voluntary athletic programs and do forever RELEASE, acquit, discharge, and covenant to hold harmless the Greater Lowell Technical High School from any and all actions, causes of action, and claims on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which I may now or hereafter have as a parent/guardian of said minor, and also all claims or right of action for damages which said minor has or hereafter may acquire, either before or after [he/she] has reached [his/her] majority resulting from [his/her] participation in the Greater Lowell Technical High School athletic programs. 9. I give my consent for my child to accompany the team on its out-of-town trips. I also understand that specific sports (including, but not limited to, Cross Country and Track & Field) may require my son/daughter to participate in training activities (ie. distance running) that will take them off of the school campus/grounds. 10. I also give my permission for the team physician, school nurse, E.M.T. or coach to render first aid as deemed necessary. 11. I give the coach or person in authority my consent to seek whatever medical treatment may be necessary in the event that my son/daughter is injured or requires medical care while in his/her charge and a parent/guardian cannot be reached. 12. I hereby give my permission for my son/daughter to participate in competitive athletics at Greater Lowell Technical High School. I understand that my child’s participation in athletic programs is voluntary and that my child and I are free to choose not to participate in these programs. I also understand and agree that such activity involves the potential for minor, major or catastrophic injuries, which are inherent in all contact/non-contact sports.
Required
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