Athletic Participation Form

OFFICE USE:

Fee Paid [ ] Emergency Card Rcvd. [ ]
All Forms Signed & Received [ ]
Academically Cleared [ ]
Physical Cleared [ ]

AMHERST PELHAM REGIONAL SCHOOLS
ATHLETIC PARTICIPATION FORM

Name_________________________Sport______________Grade___

(Please Print)

Level: Freshman_____JV_____Varsity_____ Boys_____Girls_____

Part I Student Participation (to be completed and signed by the candidate)

Age as of September 1^st _______Birthdate________________

I agree to make every effort to keep my school work up and to live to the standards of this school and the team and abide by all of the policies and procedures set forth in the ARHS Student Handbook and the rules and regulations for the Massachusetts Interscholastic Athletic Association.

Signature of Athlete Date

Part II Parental Approval (to be completed and signed by parent/guardian)

I have read the policies and procedures set forth in the ARHS Student Handbook and understand that those policies and procedures set forth therein will be enforced by the Amherst Regional High School and the Department of Athletics.

It is with my approval and consent that _______________________________________

may participate in the interscholastic Athletic Program at Amherst Regional High School. This includes practices, games and team travel. I do understand and assume that there is always the risk of possible injury to my child during such athletic activities and travel. I realize that the risk of injury may be severe, including but not limited to, the risk of fractures, brain injuries, paralysis or even death.

Signature of Parent/Guardian Print Last Name Date

Part III Insurance Coverage (to be completed and signed by parent or guardian)

I understand that my child may not participate in interscholastic athletics at the Amherst Regional Schools unless he/she is adequately covered by the School Accident Insurance Plan (offered by the school) or by a family insurance policy which will cover any possible injury. My child is covered by ___________________________________________insurance and has my permission to take part in the athletic program.

Signature of Parent/Guardian Date