

ATHLETIC PARTICIPATION INFORMATION
PARENT/GUARDIAN: Please read with your student athlete. ALL INFORMATION MUST BE COMPLETED
STUDENT ID #: ________________School Attended
Last Term__________________SPORT: _____________________________
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Student’s
Name: Male Female r
r |
Current
School: |
Birthdate: Month Day Year
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Grade in School: Currently Enrolled in ________ Courses: |
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Parent/Guardian
Name: |
Family
Physician: Phone Number: |
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Home
Address: Home Phone: Daytime Phone: |
Health
Insurance Provider: |
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City: Zip
Code: |
Policy
No Group
No: |
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ALLERGIES,
MEDICAL CONDITIONS, ETC. THAT WE SHOULD KNOW ABOUT: |
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Your
son/daughter has expressed a desire to participate in a Beaverton School District
#48 athletic activity. The school and
district staff require certain information concerning such participation which
may be helpful to you. Will you please
read and then sign this information form at the bottom of the page and return it to the appropriate
school personnel.
1. Each athlete must pay a student
participation fee. This fee
covers
participation only – no insurance included.
2. Oregon’s Legislature has passed a law
effective with the
2002-03 school year
requiring students, who participate in athletics, to pass a physical examination every two years in grades
9-12. The exam must be performed by a licensed physician (M.D. or D.O.) prior
to participating in a Beaverton School District athletic program.
All Freshman and Juniors will be required to have physicals. Any new student to the district, without a
physical in the last two years will be required to submit proof of a physical.
If a student sustains and accident, injury or serious illness, the
athlete must be cleared by his/her physician prior to participating in any
athletic activity.
3. Medical insurance
is required of all students participating in school athletics. It is understood that Beaverton School
District is not liable for any medical, dental, or hospital bills occurring as
a result of athletic injuries incurred by a student while participating in a
supervised sport, and that such bills, in excess of insurance benefits, shall
be the responsibility of the student’s parents or guardians.
4. Practice and game equipment, with some
exception, will be issued to members of competitive teams. Students will be held monetarily accountable
for school equipment issued to them.
Future participation may be withheld if restitution is not made.
5. All athletes are expected to conform to the
rules of scholastic eligibility, participation, and training rules as
prescribed by the Oregon School Activities Association, Beaverton School
District, and the athletic coaching staff.
(This information will be reviewed
by the coaching staff prior to the start of the sport season with each athlete.)
6.
When teams
travel for games with other schools outside the school district, transportation
may be furnished by the school district.
When district transportation is provided, athletes must travel both to
and from the location of the contest by school-provided transportation unless
exceptions are granted by the coach in charge.
7.
I hereby give
permission for my son/daughter to undergo medical treatment for any injury or
illness he/she may sustain or acquire while engaging in interscholastic
athletics through Beaverton School District.
I understand that the Certified Athletic Trainer and/or Team Physician
will perform only those procedures which are within their training,
credentialing, and scope of professional practice. Should hospitalization, surgery, or other
invasive procedures be required, I understand that attempts will be made to
contact me for my consent. In the event
that I am unable to be contacted within a reasonable period of time, I
authorize any duly licensed medical practitioner to perform such procedures, as
may be medically necessary to alleviate the problem.
8.
I realize no
amount of reasonable supervision or training can eliminate all the dangers of
athletic participation and that my child may suffer serious injury as a result
of participation in athletic events. Notwithstanding this possibility, and with
full knowledge and understanding of the risk of serious injury to my
son/daughter as a result of athletic participation, I give my permission for my
son/daughter to participate in all sports and activities approved by the Beaverton School District this year. If I have an exception, I have listed them below:
_____________________________________________
9. Certain athletic events may involve overnight
stays in hotels, motels or dormitories. During these occasions, supervision
will be provided by coaches or parent chaperones. Students will be expected to follow Beaverton
School District rules and
regulations. Failure to follow those
rules may result in the athlete being sent home at the parents’ expense and
suspended/expelled from the team and school.
I
have obtained the following type of insurance (check one):
(
) Private ( ) Purchased separate
coverage through school
Signature of
Parent/Guardian Date ![]()
ATHLETIC
PARTICIPATION INFORMATION REV 6/08 350