Newton-Conover Athletic Profile Sheet

NEWTON-CONOVER ATHLETIC PROFILE SHEET

LAST NAME______FIRST NAME______

DATE OF BIRTH______FALL 2017 GRADE____9TH___10TH___11TH___12TH____

YEAR YOU ENTERED 9TH GRADE______STUDENT NUMBER______

NUMBER OF CLASSES PASSED SPRING SEMESTER OF 2017 ______

ADDRESS ONLY IF OUT OF DISTRICT______

FALL SPORT(S) ______

WINTER SPORT(S) ______

SPRING SPORT(S) ______

NEWTON-CONOVER INFORMED CONSENT FORM

I hereby give my permission for______to participate

(student /athlete’s name)

in ______during the athletic season beginning in______. Further, I

(sport)(month/year)

authorize the school to provide emergency treatment of any injury or illness my child may experience if qualified medical personnel consider treatment necessary and perform the treatment. This authorization is granted only if I cannot be reached and a reasonable effort has been made to do so.

Date______Parent or guardian______

Address______Phone______

Family physician______Phone______

Preferred Hospital ______

Medical Conditions (e.g. allergies or chronic illnesses) ______

______

Other person to contact in case of emergency:______

Relationship with person ______Phone______

My child and I are aware that participating in ______is potentially a hazardous

(sport)

activity. I assume all risks associated with participation in this sport, including but not limited to falls, contact with other participants, the effects of the weather, traffic, and other reasonable risk conditions associated with the sport. All such risks to my child are known and appreciated by me.

I understand this informed consent form and agree to these conditions on behalf of my child.

INSURANCE

Newton Conover City Schools requires that all students who participate in athletics be adequately covered by medical or accident insurance. We certify that we have purchased and will maintain in full force and effect during student-athlete’s participation in athletics the following insurance policy:

Check One: □School Accident Insurance□ Personal Insurance

Name of Insurance CompanyPolicy NumberGroup Number

Insurance Phone for AuthorizationPolicy Holder

PLEASE DO NOT SIGN THESE POLICY AGREEMENTS UNTIL YOU HAVE READ, HAD OPPORTUNITY TO ASK QUESTIONS, AND HAVE DISCUSSED THEM WITH YOUR PARENT OR DAUGHTER/SON.

I understand the working of the RANDOM DRUG TESTING POLICY and agree to cooperate, or to have my son or daughter cooperate, with this policy.

______

(Parent, or Guardian, Signature)(Athlete’s Signature)

I understand the issues included in the Newton-Conover ATHLETIC POLICY and agree to abide by the items covered by this document.

______

(Parent, or Guardian. Signature)(Athlete’s Signature)

I understand the importance of good sportsmanship and will abide by the expectations expressed in our SPORTSMANSHIP STATEMENT.

______

(Parent, or Guardian, Signature) (Athlete’s Signature)

I understand the policy on the ATHLETIC TRAINER GIVING INFORMATION to the head coach in my sport, or my daughter’s/ son’s sport, and agree to accept this policy.

______

(Parent, or Guardian, Signature)(Athlete’s Signature)

I understand that I, or my daughter/son, may be permanently injured or killed while participating in the sports program in which she/he has decided to voluntarily participate during the school year and consent to participate, or allow my daughter/son to participate, regardless of this risk.

______

(Parent, or Guardian, Signature)(Athlete’s Signature)

Date: ______

(Month, Day, Year)

SPORTSMANSHIP PLEDGE

STUDENT ATHLETE PLEDGE

As a student athlete, I know I am a role model. I understand the spirit of fair play while playing hard. I will refrain from engaging in all types

of disrespectful behavior, including inappropriate language, taunting, trash talking, and unnecessary physical contact. I know the behavior expectations of my school, my conference, and the NCHSAA and hereby accept the responsibility and privilege of representing this school and community as a student athlete.

______

(Student/Athlete)

______

(Date)

PARENT PLEDGE

As a parent, I acknowledge that I am a role model. I will remember that school athletics is an extension of the classroom, offering learning experiences for the students. I must show my respect for all players, coaches, spectators and support groups. I will participate in cheers that support, encourage, and uplift the teams involved. I understand the spirit of fair play and the good sportsmanship expected by our school, our conference and the NCHSAA. I hereby accept my responsibility to be a model of good sportsmanship that comes with being the parent of a student/athlete.

______

(Parent(s)

______

(Date)

RESIDENCE (Please check the appropriate box)

______My son/daughter lives with one/or more natural parent(s) in the Newton-Conover school district.

______My son/daughter lives with one/or more natural parent(s) and lives outside the Newton-Conover City School district, but he/she has been released by the system within whose district we reside and has been accepted by the Newton-Conover City School System.

______My student/athlete does not live with a natural parent, but I have been assigned custody (not guardianship) by court order or by social services agency decision and we reside outside the Newton-Conover City school district but he/she has been released by the system within whose district we reside and has been accepted by the Newton-Conover City School system.

______The residence of my student/athlete does not fit in any of these categories and needs to be discussed individually.