Parent's Athletics Registration Form

Student Athlete Information

Last Name *

First Name *

Grade

Sex *

What Fall Sport Would You Like To Signup For?

What Winter Sport Would You Like To Signup For?

What Spring Sport Would You Like To Signup For?

Student Cell Phone *

City *

Zip *

Home Phone

Parent/Guardian Information

Mother or Primary Guardian First Name (if none, please type none)

Mother or Primary Guardian Last Name (if none, please type none)

Mother Email Address (if none please type none@aol.com) *

Mother/Primary Guardian Cell Phone

Father or Other Guardian First Name (if none just type none)

Father or Other Guardian Last Name (if none, just type none)

Father's Email Address (if none type none@aol.com) *

Father/Guardian Cell Phone

Additional Student Information

Birth Date (mm/dd/yyyy)

Age as of September 1st *

Date of most recent physical examination (mm/dd/yyyy) *

Did you attend any other high school last year - even for a single day? *

Did your child attend another high school other than Whitman-Hanson last year? If yes, please see email Mr. Rodgers immediately to explain the details. *

Has your child repeated a grade in high school? *

Will Your child Be 19 before September 1st this year? *

Rules/Policy Acknowledgement

1. In order for a student to tryout, practice or participate in any capacity, he/she must be academically eligible. For the fall season, the student must have accumulated 20 credits the previous school year (students may take summer school to make up credits. A student must pass 5 full credit classes in each subsequent marking period to maintain eligibility and must take 5 full credit classes at all times. *

I Understand and Accept This Rule

2. A student must not turn 19 before September 1st. If you do, you must see the athletic director so a waiver can be pursued through the MIAA. If you participate without the waiver, your team will forfeit all games in which you participate. In order to participate in freshmen sports, you must not turn 16 before September 1st. *

I Understand and Accept This Rule

3. All students may only be eligible to play 4 years of high school sports at Whitman-Hanson. That clock begins to count in the summer of their freshman year regardless of whether they played a sport or not. This means a student who repeats a year of school would not be eligible for a 5th year of athletics. A waiver is possible for any student who does not meet this rule but it must be addressed PRIOR to the start of tryout and the earlier the better. If a 5th year student participates without a waiver the team will forfeit every game the player appeared in. *

I Understand and Accept This Rule

4. All athletes must have an up to date physical on file with the school nurse before being allowed to tryout or participate in any sport. A physical is valid for 13 months from the date it was conducted. A student becomes ineligible to participate when the physical expires. It is the responsibility of the student and parent to be sure they have an up to date physical. It is quite possible that there will be no reminder that your physical is set to expire. We recommend that each student keep a copy of their most up to date physical on their phone. Updated physicals should be mailed to physicals@whrsd.org *

I Understand and Accept This Rule

5. All student-athletes and parents MUST read the section on hazing in the WHRHS student handbook. Hazing is a very serious infraction and Whitman-Hanson follows the letter of the law. *

I Understand and Accept This Rule

6. Students must attend school to practice or compete in a game on that day. Students who come in late must be in school by midway through period 1 in order to participate that same day. Any student, who gets dismissed from school because he/she is ill, is ineligible that day regardless of whether they were in school for half the day or not. Absences, tardies and dismissals due to funerals, doctor’s appointments, college visits or other special circumstances must be cleared through the athletic director and be accompanied by proper documentation where appropriate. *

I Understand and Accept This Rule

7. Students who serve an extended detention, are suspended from school or are on the stop list may not participate in any extra-curricular activity that day. A student who participates despite being ineligible would cause his/her team to forfeit the contest. *

I Understand and Accept This Rule

8. The MIAA Bona Fide Team Member Rule #45 is in effect here at Whitman-Hanson. This rule states that no high school athlete may skip (or leave early/arrive late) a practice or game in order to participate in an athletic event with a non-school team. A coach does not have the authority to grant permission for a student to miss a high school event for a non-school event. There is a waiver process which can be filed if the athletic director is notified in advance (please give at least 2 weeks notice). Team discipline may still apply and is at the sole discretion of the coach. *

I Understand and Accept This Rule

9. The complete MIAA “Chemical Health” rule can be found on page 51, 52 and 53 of the MIAA handbook which can be found at www.miaa.net or you may also receive a copy from the Whitman-Hanson Athletic Director. This rule states: “From the earliest fall practice date (the first day football practices), to the conclusion of the academic year or the final athletic event (whichever is later), a student shall not use, consume, possess, buy/sell or give away any of the following: a) A beverage(s) containing alcohol; b) any tobacco product c) marijuana d) illegal steroids e) or any other controlled substance The penalties for violation of this rule are spelled out in the MIAA handbook. In addition, students who are in violation of this rule may not serve as a captain in any sport for one full year and they may not be named as an all-star for any sport in which they served a chemical health violation suspension. Please note the use of all E-Cigs, Vap Pens and all similar devices are also a violation. Whitman-Hanson has the added, "In the Presence Of" component of this rule. Any student-athlete found to be knowingly in the presence of illegal use of drugs or alcohol shall be suspended for one game and lose all leadership positions. Any student-athlete with any type of chemical health violation will be ineligible to be a league all-star. *

I Understand and Accept This Rule

10. Coaches of each sport will determine team rules for such matters as missed practices, being late to practice, general behavior, etc. However, the Athletic Director reserves the right to remove or suspend a player who is determined to be out of compliance with the practice/game attendance policy. Students are expected to attend all practices and games unless there is a valid reason for missing (jobs, family vacations, concerts, pro sporting events and other similar activities are not valid reasons for missing a practice or game). While school trips are excellent experiences for students, the commitment each one of them makes to their team should take precedence. Therefore, any student who leaves the team in order to attend a school trip will have their standing on the team impacted in some fashion. Each coach will determine how the missed time will affect the student. Therefore the student-athlete should discuss the trip with their coach BEFORE committing to the trip. *

I Understand and Accept This Rule

11. Good Citizen Rule – All Whitman-Hanson student athletes agree to conduct themselves in a manner which reflects a high level of respect for our community. Students who engage in any form of bullying, harassment, vandalism or in any way break the law are subject to suspension or removal from the team. Students who use technology (facebook, cellphones, etc) inappropriately will also face severe consequences. At no time should a Whitman-Hanson student athlete engage in online arguments or confrontations with students from other schools, teammates, coaches or anyone else related to their athletic experience. *

I Understand and Accept This Rule

12. All Whitman-Hanson student athletes, parents and coaches are responsible for understanding and abiding by all rules outlined in the Whitman-Hanson student handbook, Patriot League Handbook and the MIAA handbook (www.miaa.net). Students are responsible to abide by all rules, even those instituted, amended or revised after the date of this form. *

I Understand and Accept This Rule

12. I agree to notify the athletic director, school nurse and athletic trainer in writing (letter or email) if my child has any changes in their medical conditions during the school year. This includes notifying the school if my child has any type of head injury away from school. *

I Understand and Accept This Rule

13. I give my child permission to participate in all strength and conditioning programs (and all similar activities) during the entire year (including summer). These programs are voluntary but by checking this acceptance I am simply agreeing to allow my child to participate if they so choose. *

I Understand and Accept This Rule

14. I give my permission for my child to utilize insect repellent at the coach's or school's discretion. I understand the school will not force my child to be sprayed, but if they opt to be sprayed, I am giving my permission. *

I Understand and Accept This Rule

15. I give my permission for my child to participate in games, practices and other team events with the full knowledge that it comes with a level of risk as it relates to Covid 19. I will not hold the school responsible or liable should my child or anyone connected to my child (family and friends) contract the virus. In addition, I agree to notify the school immediately if my child or someone in my household contracts the virus. I understand that the school nurse will determine the course of action to take in the event there is an illness or exposure to illness and I agree to abide by the directives set forth. *

I Understand and Accept This Rule

16. I give my permission for my child to be transported under the direction of school personnel. Sometimes, teams travel by bus, van and private transportation. Coaches sometimes drive their own vehicles and transport students when other transportation is not available or not cost effective. *

I Understand and Accept This Rule

17. I understand that participating in Whitman-Hanson athletics requires a user fee that should be paid prior to the fist contest unless a special arrangement has been made with the athletic director. The user fee is currently $250 for the first sport and each additional sport is $50 with a family cap of $600. Also both boys and girls hockey requires an additional $200 user fee (this is not affected by the family cap). All user fees are non refundable. No refunds are given or obligations removed if a student leaves a team for any reason (injury, quit, removed from team, etc). No student may carry a user fee balance from the previous school year into the new school year. You may pay online at www.whathletics.com . Please make sure your account is current to avoid any disruption in participation. You may find your child's balance on the parent portal of infinite campus under the tab FEES. *

I Understand and Accept This Rule

18. As a student-athlete of a Massachusetts Interscholastic Athletic Association member school, I agree to abide by all guidelines regarding the use or exhibition of discriminatory practices. I PLEDGE TO: 1. Help create and foster a safe environment within the school community, which includes the responsible use of social media. 2. Consistently model respect and tolerance by setting an example of good sportsmanship and positive behavior, including language (body and spoken), gestures, signs, and overtures. 3. Not enable my fellow student-athletes who use abusive language, signs, gestures, or overtures. I will not cover up for them or lie for them if any rules are broken. 4. Hold myself, my fellow student-athletes, and our community responsible and accountable for their actions. 5. Seek information and assistance in dealing with my own or my fellow student athlete’s negative behaviors, problems, or concerns. 6. Be open and honest with my coach and other school personnel when the best interest of myself, my fellow student-athletes, and my school are being jeopardized. 7. Thrive to create a school without hate.

I Understand and Accept This Rule (must be selected by the student)

I choose not to agree to this pledge

19. I understand that Massachusetts state law requires all parents to be educated in the danger of concussions. I agree to either attend the athletic first night program on 8/18/24 OR to take the free online course provided by the NFHS - https://nfhslearn.com/courses/concussion-in-sports-2 . In both cases, I understand that if I have any questions, I may speak to the athletic director or athletic trainer. *

I Understand and Accept This Rule (must be selected by the student)

20. If, after filling out this form, my child elects to change sports, I agree to apply all of the provisions and waivers to that new sport. I further agree to apply all of the provisions and waivers of this form to any activity my child participates in as it relates to Whitman Hanson athletics. *

I Understand and Accept This Rule (must be selected by the student)

Athletic Department Injury Policy: Whitman-Hanson Regional School district accepts no liability for any injuries sustained while competing, practicing or attending any athletic event, game, match or any other similar activity regardless of the location of the event. Parents accept all responsibility to ensure their child is properly equipped and using all available safety equipment (chest protectors, athletic cup, masks, mouth guards, etc). Further, the school district will not file an insurance claim on behalf of a student if there is an injury. Parents and guardians are required to maintain insurance for their child. Parents should be aware of all restrictions, co-pays and deductibles in their policy as some insurance companies specifically exclude injuries sustained while competing in school sports. Whitman-Hanson Regional School District does provide the opportunity for parents to purchase, at their own expense, a supplemental insurance policy which is available at www.whathletics.com . Information about this policy is available on the school website (www.whrsd.org) and the athletic blog (www.whathletics.com). If I am unable to obtain the information online, I understand I may contact the athletic director to get the necessary information. *

I Understand and Accept This Policy. I understand that it is my responsibility to maintain insurance coverage for my child. I also understand that I have the right to purchase insurance from the school but in the absence of that purchase my child is not covered under the school's policy.

I, on behalf of myself or as the parent or legal guardian of the above named athlete (if athlete is under 18 years of age), hereby give my consent to Signature Healthcare (an entity which includes Brockton Hospital and Signature Medical Group) and its healthcare providers and athletic trainers to provide sports medicine services to the Athlete as part of his/her participation in school’s athletic program. The sports medicine services provided may include, but are not limited to: screenings, physical exams, and athletic trainer services. I grant permission to Signature Healthcare’s providers and athletic trainers to provide such services to Athlete as deemed necessary for such providers and athletic trainers for any athletic injury treatment or prevention. I further grant permission for Signature Healthcare’s providers and/or athletic trainers to treat Athlete for any injury or condition that arises out of Athlete’s participation in the school’s athletic program. I understand that the services provided by Signature Healthcare’s providers and/or athletic trainers relate to sports medicine services and are not intended to be a complete medical examination. I understand that the above named school’s athletic programs are, by their very nature, capable of causing injury to the Athlete. I hereby release Signature Healthcare and it’s providers and athletic trainers from any and all liability associated with the care, treatment, examination or other sports medicine services provided to Athlete as part of Athlete’s participation in the School’s athletic program(s). *

I Understand and Accept This Policy. I understand that it is my responsibility to maintain insurance coverage for my child. I also understand that I have the right to purchase insurance from the school but in the absence of that purchase my child is not covered under the school's policy.

I authorize Signature Healthcare’s providers and/or athletic trainers to use or disclose Athlete’s Protected Health Information to the following: the School and any individual involved in the operation of the School’s athletic program(s), including without limitation athletic trainers, coaches, referees and athletic directors. I authorize Signature Healthcare’s providers and athletic trainers to use or disclose Protected Health Information for the following purposes: To inform the above-named individuals of sports injuries sustained by Athlete To inform the above-named individuals of other medical conditions that could affect Athlete’s participation in School’s sports program(s) I understand that: 1. The Protected Health Information used or disclosed under this authorization may be subject to redisclosure by the receiver and no longer protected by confidentiality or privacy laws. 2. Authorizing the disclosure of this information is voluntary and is not required for treatment or payment purposes. 3. I can revoke this authorization at any time by writing to: Signature Healthcare Attn: Sports Medicine Program 110 Liberty Street – Orthopedics Department Brockton, MA 02301 4. I specifically authorize the disclosure of information regarding substance abuse, mental health treatment or reproductive health. This authorization will expire when Athlete no longer participates in School’s athletic program(s *

I understand and accept this release form

Date (mm/dd/yyyy) *

Electronic Signatures Are Binding. By typing my name, I am signing that I agree with all of these provisions. Parent/guardian please sign *

Electronic Signatures Are Binding. By typing my name, I am signing that I agree with all of these provisions. Student please sign *

Permission Slip

I give my permission for my son/daughter to participate in the Whitman-Hanson athletic program. I have read the student contract which my child has signed and I agree to all of its provisions. I understand all of the rules. I understand that it is my responsibility to read and understand the MIAA handbook (which is found at www.MIAA.net) and the Whitman-Hanson student handbook (found online at www.WHRSD.org). I give my permission for my son or daughter to be transported by school transportation whether it is by bus, van or car. I understand that at times, a coach, assistant coach or another agent may be driving the vehicle. I agree to hold the driver and the school district harmless of any liability in the event of an injury. I also understand that Massachusetts General Laws require all parents of students participating in high school athletics to become educated on the serious issues of head injuries and concussions. I have met the education requirement by either attending the pre-season athletic presentation or by completing the online course. By signing this, I am affirming that I have indeed complied with this obligation and that I have no questions with regard to the concussion policy or any issues relation to concussions. I understand that in order to participate in the Whitman-Hanson Athletic program, I must pay a $250 user fee for the first sport and $50 for each additional sport during the same school year. I understand that this user fee in no way entitles my son/daughter playing time and in the event my child is removed from the team, either voluntary or involuntary no portion of the user fee shall be refunded. We do hereby consent to his/her participation in voluntary athletic programs and do forever RELEASE, acquit, discharge, and covenant to hold harmless the Whitman-Hanson Regional School District, a municipal corporation of the Commonwealth of Massachusetts, and its successors, departments, officers, employees, servants, and agents including but not limited to: Ridder Farm Golf Club, MGC Pembroke, The Kingsbury Tennis Club and Rockland Ice Rink, expenses and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damage which we/I may now or hereafter have as the parent(s) or guardian(s) 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 or to result from his/her participation in the Whitman-Hanson Regional School District’s athletic programs; FURTHERMORE, we/I hereby agree to protect the Whitman-Hanson Regional School District and its successors, departments, officers, employees, servants and agents (including but not limited to: Ridder Farm Golf Club, MGC Pembroke, The Kingsbury Tennis Club and Rockland Ice Rink,) against any claim for damages, compensation or otherwise on the part of said minor growing out of or resulting from injury to said minor in connection with his/her participation in the Whitman-Hanson Regional School District’s voluntary athletic programs, and to INDEMNIFY, reimburse or make good to the Whitman-Hanson Regional School District or its successors, departments, officers, employees, servants and agents any loss or damage or costs, including attorney’s fees, the Whitman-Hanson Regional School District or its representatives may have to pay if any litigation arises from said minor’s intentional, grossly negligent, or reckless acts or omissions while participating in said sports programs. I further give my permission for my child to participate in out of season leagues, training, conditioning and other similar programs and agree to accept all liability for participation. I understand that these off season programs are not required and are not supervised by our school district. As the parent/guardian I agree to accept all responsibility for all participation and hold the school district and all activity organizers and participants free from any liability what so ever. This waiver extends for the duration of my child’s enrollment at Whitman Hanson or until such time I notify the school district in writing of my desire to terminate this waiver. *

I fully understand and accept all of the provisions outlined above

At Whitman Hanson we do our best to provide transportation to and from athletic events. However, if we are unable to secure transportation or cannot provide it for any reason, please select the permissions you will allow for your child. *

My child my drive to the event

My child may drive with another student to the event

My child may drive with a coach or school official to the event

My child may drive with another parent to the event

I do not give any permission and understand my child will not be penalized for missing the event.

Date (mm/dd/yyyy) *

Date (mm/dd/yyyy) *

Electronic Signatures Are Binding. By typing my name, I am signing that I agree with all of these provisions. *

Pre-Participation Medical History Form (A school nurse is not present at games or practices)

Student's First Name *

Student's Last Name *

Grade *

Parent Guardian Name *

Best Contact Phone Number *

1. Has your child had a medical illness or injury since his/her last checkup or sports physical? If yes, please explain. *

2. Is there a physical condition or ailment that you would like your child’s coach to be made aware? Please explain *

3. Has your son or daughter ever been diagnosed with a concussion? If yes, to the best of your memory, please list the date of each instance *

4. Is there anything else you would like to inform the trainer or coach about your son or daughter’s medical history? *

Date (mm/dd/yyyy) *

Electronic Signatures Are Now Binding. By typing my name, I am signing that I agree that all of this information is accurate *

Whitman-Hanson Athletics - Emergency Contact Card

Student First Name *

Student Last Name *

Date of Birth (mm/dd/yyyy) *

Allergies (including meds) (if none, please type none) *

Does your son/daughter have a history of any of the following:

Allergies that require the use of an epi-pen

Diabetes

Asthma that requires the use of an inhaler

A heart condition

Emergency Contact #1 Name *

Emergency Contact #1 Phone *

Emergency Contact #2 Name *

Emergency Contact #2 Phone *

Emergency Contact #3 Name *

Emergency Contact #3 Phone *

I give my permission for the team physician, school nurse, athletic trainer, E.M.T., paramedic, coach or other first-responder to render first aid or other appropriate medical treatment deemed necessary by the person or persons providing the care. This permission extends to all hospital personnel. However, I do not hold any of the above responsible for the medical care or lack there-of. Although I expect every attempt to contact me (emergency contact #1), I understand that this is not required. By typing my name in this box, I agree that this electronic signature affirms my approval. *

Date (mm/dd/yyyy) *