2018-2019 Midland High School Athlete Registration
This registration is only good for one student. If you have multiple students in your home that will participate, each one will need to be logged individually by clicking submit another response at the end of this form. If the student is in middle school you'll need to go back to the presentation and click on the MMS link to complete the middle school athlete registration.
Student's name: *
Your answer
Student athlete birthdate *
MM
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DD
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YYYY
Parent's name: *
Your answer
Address: *
Your answer
Parent phone number: *
Your answer
Athlete phone number: *
Your answer
Please select the grade the athlete will be entering in the Fall of 2018. *
Student Athlete Medical Information
Family doctor: *
Please list the doctor's name and phone number.
Your answer
Emergency contact *
Please list at least one person we may contact in the event we can't reach a parent or guardian and their relationship to the student athlete.
Your answer
Proof of insurance *
If your student athlete is participating in an athletic sport, we need to know that they have accident/health insurance and that they are covered during an athletic contest. Please include the name of the insurance company and a policy number.
Your answer
Please list any previous medical conditions including allergies, medications, conditions, and any known restrictions. *
Your answer
In the event of a medical emergency and if reasonable attempts to contact me using the telephone numbers listed above are unsuccessful I, as parent or legal guardian of the student athlete, do hereby authorize: Treatment by a licensed medical physician of my child in the event of a medical emergency that in the opinion of the attending physician, may endanger his/her life, cause disfigurement, physical impairment, or undue discomfort if delayed, and transfer of my child to any hospital reasonably accessible at my expense. *
Consent to Random Testing
We consent to random testing in accordance with the IHSA's Steroid testing policy and the Midland CUSD #7 Drug Testing Program. We understand that, if the student or the student's team participates in state series competitions, the student may be subject to testing for banned substances. *
No student-athlete may participate in IHSA state series competition unless the student and the student's parent/guardian consent to random testing.
IHSA Concussion Notification
We have read and agree to the IHSA concussion sheet. *
We have read through the Midland Concussion Management Program. *
Acknowledgement of Rules and Regulations
This page will serve as your final step for registration. Please click on the link for a copy of the Midland High School Handbook.
We have read and understand all of the rules and expectations of the Midland CUSD #7 Athletic Handbook. *
Click on the link to view the Midland Athlete Handbook in its entirety: https://drive.google.com/file/d/0B3YxDCV_lnrkRW83ekN1UXN0cnM/view?usp=sharing
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