Collinsville Middle School Online Athletic Registration Form
Parents of athletes must complete the online registration before trying out for a sport.

Completion of this process does not guarantee the student athlete will be a member of the team. Coaches will make decisions on final rosters for each sport upon completion of tryouts.

In typing in your name (Parent/Guardian & Student) in this registration, you signify that your electronic signature represents the person named and acknowledges a full understanding & acceptance of the athletic rules and agreement.

*In providing your address, you are confirming that the student-athlete and the parent(s)/court-appointed legal guardian reside full time in the attendance boundaries of Collinsville Middle School.

If you have questions or need to contact me about conflicts, please call 618-343-2146 or e-mail mhayman@cusd.kahoks.org.

Email address *
Sport *
Student-Athlete's Last Name *
Your answer
Student-Athlete's First Name *
Your answer
Grade *
Are you currently on another CMS sport team (Volleyball, Wrestling, Bowling, Dance Team) ***Remember your season must be over before trying out***
Date of Birth *
MM
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DD
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YYYY
Street Address *
Your answer
City *
Your answer
Physicals are only good for 13 months.
Athletes must have a current physical that will be valid through the whole season. A copy of a current physical must be on file with the nurse's office at Collinsville Middle School prior to tryouts. Student athletes will NOT be able to participate in tryouts until a copy of a current physical is on file with the Nurse's office. Please contact the nurse at 618-343-2161 if you are unsure. Blank physical forms can be found here: https://www.sijhsaa.com/images/stories/pdf/Physical_Exam_Form_IHSA.pdf
What is the date of the most recent physical? *
MM
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DD
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YYYY
Is the student-athlete allergic to any medications? (asprin, penicillin, sulfa, etc.) List all. *
Your answer
Does the student-athlete take any permanent or occasional prescribed medications? (antibiotics, anti-inflammatory, etc.) List all. *
Your answer
Has a doctor diagnosed the student-athlete with asthma and prescribed an inhaler? Please list and explain the severity. *
Your answer
Does the student-athlete have any conditions we or emergency room staff should be aware of in case of an emergency? (insect or food allergies, tendinitis, etc.) *
Your answer
What is the date of the last Tetanus shot? (Please contact family physician if unknown). *
MM
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DD
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YYYY
Please provide the following insurance information in case of an emergency: Insurance Company; policy #; Group #; Insurance phone #; Primary Person Insured. *
Your answer
Communication & Understanding:
The key to every positive relationship. I will communicate all information in the following ways, but it is up to you to make sure there is understanding:

1. Face to face with athletes and parents whom seek me out in meets or practice. All athletes need to know what is coming up and what is going on all the time. At the very least, they need to know how and where to find the answers to the questions they/you have.

2. Our website, Google Classroom, and the REMIND APP. At the beginning of each week I will write and send/post the following weeks events and info that we will go over with the athletes. Any emergency changes will also be delivered to all three methods as well as athletes using their phones to text/call you with their phones, school's phone, or mine.

Side Note: We believe that the best form of communication that ensures understanding is face to face. I feel that there was better communication & understanding before there were cell phones and the internet. This is why it is important to attend the parent meeting and seek out coaches during pick-up, practices, or meets. Creating a positive working relationship is important to us.

Parent Responsibilities:
1. Ask questions of your athletes and be informed of what is going on.

2. Pick up from practices and after meets in a reasonable amount of time. Have plans B and C in place when "life" happens. We are all busy and have families, and cars that can break. We understand this. We don't understand why you didn't know there was a meet or why you are shopping at Walmart when we have been waiting for 30 minutes.

3. Sign the sign-out sheet from the coach if taking your student-athlete home directly from an away meet. This is very important. Meets are hectic and busy and it will be difficult, but you need to find the coach to sign your child out. We like our jobs and want to ensure everyone gets home.

4. If you are taking your student-athlete from an away meet, they need to take their school stuff with them when get off the bus and give them to you for safe keeping and in case of rain. Most of the meets are in April and it will be wet. During meets the bus will be locked until the meets are over.

5. Encourage your athletes in a positive way. This is most of what we are doing as well. We want athletes to stick with the sport and get back up again when they fall or feel discouraged. High school is the great equalizer. JV runners in middle school can be Varsity runners in high school. But that only happens when they stick with their sport.

6. Respect us enough, if something happens, to discuss it in a calm and rational way. We do the best we can everyday and strive for perfection while being imperfect. I'll own my mistakes and learn from them. However, if we need mediation with the school principal I can set that up as well. Any dispute that cannot be resolved between the coach and parent starts there.

7. Have fun. Being a small part of our athletes' success is why we are involved in coaching and teaching.

8. A Parent/Guardian Meeting will be scheduled before the season starts after practice. Please attend this so we can meet each other and answer any questions you may have. We will also need parents to help run our events that we host.

Mother/Guardian Name *
Your answer
Mother/Guardian E-mail *
Your answer
Mother/Guardian Cell, Home, & Work Phone Numbers (xxx)-xxx-xxx. Please Identify each. *
Your answer
Father/Guardian Name *
Your answer
Father/Guardian E-mail *
Your answer
Father/Guardian Cell, Home, & Work Phone Numbers (xxx)-xxx-xxx. Please Identify each. *
Your answer
Are you willing to help run an event in our inter-squad meets?
Athlete's Cell Phone (xxx-xxx-xxx) *
Your answer
Emergency Contact #1 Name *
Your answer
Emergency Contact #1 Phone Number(s) (xxx)-xxx-xxx. *
Your answer
Emergency Contact #2 Name *
Your answer
Emergency Contact #2 Phone Number(s) (xxx)-xxx-xxx. *
Your answer
Further Information that you feel the coaches should know...if any? If none, write, "None". *
Your answer
Concussions
Please click on the link below to read the SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION CONCUSSION ACKNOWLEDGEMENT AND CONSENT FORM.
(https://www.sijhsaa.com/images/stories/pdf/Concussion_Acknowledgement_and_Consent_Form.pdf)

Please click on the link below to watch the following video/presentation on concussions:
https://www.ihsa.org/multimedia/articulate/2015-16/concussion/presentation.html

If your student-athlete does incur a concussion, a post-concussion consent form must be filled out and submitted before returning to practices and/or events.

Please click on the link below to read the SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION POST-CONCUSSION CONSENT FORM.
https://www.sijhsaa.com/images/stories/pdf/Post_Concussion_Consent_Form_IHSA_SIJHSAA.pdf

Athletic Codes of Conduct, Eligibility, and Fees.
Please click on the link below to read the Athletic Codes of Conduct, Eligibility, and Fees information for Collinsville Middle School Athletics.

https://docs.google.com/document/d/1ulmw1hlyQLgqK8hUONlG_gbY84vXufEMzGdH_219eck/edit?usp=sharing

Southern Illinois Junior High School Athletic Association By-Laws that includes rules for qualifications for competing at State.
Please click on the link below to read the Southern Illinois Junior High School Athletic Association By-Laws.


https://docs.google.com/document/d/1eOPs-UKcWrWLEnWlePg1iKW_YAGtMZlg769k-GD65Qc/edit?usp=sharing

In typing in your name (Parent/Guardian & Student) in this registration, you signify that your electronic signature represents the person named and acknowledges a full understanding & acceptance of the athletic rules and agreement.
I, the undersigned, being the parent or legal guardian of the undersigned student athlete(s), do hereby grant to any hospital, emergency center, doctor, nurse, and/or paramedic, authorization to grant treatment to the undersigned student athlete(s), when accompanied by or escorted to the treatment facility by a teacher, coach, teacher's aid, principal or any member of the Collinsville Unit School District #10 Board of Education.

Further, should the attending physician determine after examination that life-saving surgery procedures might be necessary, permission is hereby extended to the above parties to grant same.

Additionally, I agree to hold harmless such personnel and the Collinsville Unit #10 Board of Education by my action of granting said permission.

CODE OF CONDUCT & ATHLETIC ELIGIBILITY REQUIREMENTS (Click link below)
(https://docs.google.com/document/d/1ulmw1hlyQLgqK8hUONlG_gbY84vXufEMzGdH_219eck/edit?usp=sharing)
I have read and I understand and agree to conduct myself in accordance with the conditions of the District 10 Code of Conduct and the SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION Eligibility Rules.
*** ALL STUDENTS WHO PARTICIPATE IN ATHLETICS AND EXTRA-CURRICULAR ACTIVITIES ARE AUTOMATICALLY SUBJECT TO THIS CODE OF CONDUCT. ***

I understand and agree to conduct myself in accordance with the conditions of the District 10 Code of Conduct and SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION Eligibility Rules.

I also approve of the conditions of the District 10 Code of Conduct and the SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION Eligibility Rules.

PERMISSION TO PLAY AND INTENT TO FOLLOW RULES
I am aware that playing or practicing to play any sport can be dangerous involving many RISKS OF INJURY. I understand that the dangers of playing or practicing include but are not limited to death, serious neck and spinal cord injuries which may result in paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles and all other elements of the skeletal/muscular system.

I recognize the dangers of practicing or playing and agree to assume the risk. I also recognize the importance of following the coaches and instruction regarding skills, safety, and team rules.
My son/daughter has my permission to play/practice in school-sponsored sports. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and for all members of my family.

I have read and I understand the SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION CONCUSSION ACKNOWLEDGEMENT AND CONSENT FORM. As a condition of participation, I agree to abide by them and have signed below.
(https://www.sijhsaa.com/images/stories/pdf/Concussion_Acknowledgement_and_Consent_Form.pdf)

I have watched the IHSA Concussion Video. As a condition of participation, I agree to abide by them and have signed below. (https://www.ihsa.org/multimedia/articulate/2015-16/concussion/presentation.html)

I am aware of and have read the SOUTHERN ILLINOIS JUNIOR HIGH SCHOOL ATHLETIC ASSOCIATION POST-CONCUSSION CONSENT FORM.
(https://www.sijhsaa.com/images/stories/pdf/Post_Concussion_Consent_Form_IHSA_SIJHSAA.pdf)

Full Names of Student-Athlete(s)
Your answer
Full Name(s) of Parent/Guardian(s)
Your answer
A copy of your responses will be emailed to the address you provided.
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