Class of 2024 through 2026 (Middle School) Athletic Online Forms - PART 2 for 2019-20
Maconaquah Schools REQUIRES information and consent to be submitted by parents and students for athletic eligibility each school year. This form should be completed in the presence of Parent AND Student--THERE ARE 2 PARTS to SUBMIT:

PART 1: The IHSAA Pre-Participation Physical Evaluation Form MUST BE PRINTED from our web site and received as hard copy only. The IHSAA form includes a page that a PHYSICIAN ONLY (NP signature not accepted) must complete. Physical must be completed on/after April 1, 2019.

PART 2: This electronic document fulfills requirements including:
* Athletic Consent Form
* Code of Conduct
* Concussion and Sudden Cardiac Arrest Acknowledgement
* Community Health Network - Consent for Athletic Training Services


Please complete these questions to complete PART 2- for Athletic Eligibility in Athletics Athletics for 2019-20 school year.
Complete all pages, then SUBMIT button.

Student Athlete - (FIRST Name) *
Your answer
Student Athlete - (LAST Name) *
Your answer
Date of Birth *
MM
/
DD
/
YYYY
Year of Graduation - (Student) *
1st Parent Name *
Your answer
Address *
Your answer
City *
Your answer
Zip *
Your answer
1st Parent Cell Phone *
Your answer
1st Parent Email *
Your answer
2nd Parent Name
Your answer
2nd Parent Cell Phone
Your answer
2nd Parent Email
Your answer
Emergency Contact Name/Phone Number *
Your answer
Preferred Hospital *
Your answer
Has this student athlete transferred to Maconaquah Schools from ANOTHER high school? *
Is your child subject to chronic disease or illness? *
Is your child subject to motion sickness? *
Does your child have Handicaps that require special attention? *
Is your child subject to epileptic seizures? *
Is your child currently taking prescribed medication *
Please list any prescribed medication.
Your answer
Please list all known Allergies (i.e.: antibiotic, insect stings, etc.):
Your answer
In the event of illness or injury, do you wish to have school personnel administer emergency first aid? *
In the event that is necessary for your child to be taken to a hospital while partipating in athletics, every effort will be made to contact you before medical services are rendered. In the event no parent contact can be made, do you wish to have your child treated by emergency room personnel of the hospital while school staff continues to make contact with parents? *
Transportation: Do you grant Maconaquah Schools to provide to transportation to and from all athletic activities your child takes part in? *
As PARENT, I grant my permission for the above described child to participate in the Maconaquah Athletic Program (Home and Away Activities), and to the best of my knowledge all of the information listed above is accurate and complete. *
By PARENT typing their name below, this is acting as your electronic signature.
Your answer
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