CMHS Athletics Registration
Prior to participating in an organized team activity, please complete this registration for your student. In order to participate all athletes must:
1. Complete this registration
2. Pay a $100 user fee (in full or arrangements for payment made with afroke@csd.k12or.us)
3. Be in good academic standing (be on track to graduate, pass 5 courses the previous semester)
4. Have a valid Oregon Physical Examination (expires every two years)
Email address *
Student Last Name *
Your answer
Student First Name *
Your answer
Student Birth Date *
MM
/
DD
/
YYYY
Mailing Address *
Your answer
Phone number *
Your answer
Fall Athletic Registration
Cheer
Cross Country
Football
Soccer (Girls)
Volleyball
MS Cross Country
MS Football
MS Volleyball
Fall
Winter Athletic Registration
Boys Basketball
Girls Basketball
Cheer
Wrestling
MS Boys Basketball
MS Girls Basketball
MS Wrestling
Winter
Spring Athletic Registration
Baseball
Softball
Track and Field
MS Track and Field
Spring
Insurance Information
No student may participate in an athletic program without insurance coverage.
Insurance Provider *
Your answer
Policy Number *
Your answer
Emergency Contact Information
Please complete this information. In an event of an injury/emergency we will contact these numbers and provide necessary insurance information to emergency services.
First Emergency Contact Name *
Your answer
Phone Number *
Your answer
Relationship *
Second Emergency Contact Name *
Your answer
Phone Number *
Your answer
Relationship *
Medical Information
Please provide the following information to ensure that the adult responsible for supervising your child has all of the relevant medical information
Medications *
Your answer
Concerns or Comments (physical limitations,history of concussions, etc.) *
Your answer
School Policy Information
By providing your consent to participate, your child is accepting all of the CMHS policy and handbook expectations for being a student athlete. Being a student athlete is not a guaranteed right, but a privilege and as such the expectations are high than for the general student.
Do you acknowledge the expectations of your student as laid out in the CMHS Student and Parent Athletic Handbook?(http://images.pcmac.org/SiSFiles/Schools/OR/ClatskanieSchoolDistrict/ClatskanieHigh/Uploads/DocumentsCategories/Documents/Student_Parent_Athletic_Handbook_2015.pdf) *
Do you and your student consent to have your student-athlete be enrolled in the Random Drug Testing Policy (http://policy.osba.org/clatskanie/J/JFCIA%20R%20D1.PDF) *
Do you wish to grant permission for your student to ride home following contests with a family member over 18 or adult over 21? If so please state those individuals (if consent is to be removed it must be stated in wiriting to the CMHS office)
Your answer
Do you understand the terms and conditions of the athletic code of conduct, as described in the CMHS student handbook (http://images.pcmac.org/SiSFiles/Schools/OR/ClatskanieSchoolDistrict/ClatskanieHigh/Uploads/DocumentsCategories/Documents/Handbook_17-_18.pdf) *
Authorization and Consent
By typing parent and student names authorization of the information provided and consent of parental permission is granted.
Parent Name *
Your answer
Student Name *
Your answer
Today's Date *
MM
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DD
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YYYY
Do you have an active physical? *
Have you paid your user fee(s)? *
Do you require a payment plan? (if yes, we will contact you) *
A copy of your responses will be emailed to the address you provided.
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