High School Sports Sign Up Forms 2023-2024
If your student has expressed an interest in participating in Nekoosa High School sports, please fill out the form below. This may be too hard to read and fill out on a smartphone. 
Your student-athlete needs a WIAA Sports Physical Form  or a WIAA Alternate Year Physical Card submitted to the NHS Office prior to the 1st day of practice. This is to be provided separately and paper copies are available in the high school office. A current physical dated after 4/1/2023 will be good until 6/2025 (unless change of medical status). A physical on file with the NHS office dated between 4/1/22--4/1/23 will be valid until 6/15/2024 as long as the parent/guardian signs a WIAA Alternate Year Physical Card and turns it in before the 1st practice. 
All participants are required to travel to and return from all athletic contests they are engaged in on transportation provided for them by the high school.  The exception to this rule is if the participant’s parent/legal guardian is in attendance at the contest and, in person, signs out the student. The student must have a signed release on file. Coaches will be given an updated list of all students with a signed release.
Email *
Student's Last Name *
Student's First Name *
My student-athlete will participate in: (please check ALL sports for school year 2023-2024). I acknowledge that my student will read and follow the NHS Co-Curricular Code available on the district website(Families->Handbooks).   *
Required
I will sign my student-athlete out after each athletic event with the Head Coach. I understand that my student-athlete may only leave an athletic event with a parent/legal guardian. *
I understand that by signing my student up for sports, there will be a Uniform Replacement fee should my student-athlete not return any/all of their issued uniform/sport at the conclusion of their season. *
PARENT/GUARDIAN & STUDENT AGREEMENT:
As a parent/guardian and as an athlete it is important to recognize the signs, symptoms, and behaviors of concussions and sudden cardiac arrest. By signing this form, you are stating that you have read the Department of Public Instruction’s (DPI) and the Wisconsin Interscholastic Athletic Association (WIAA) Concussion and Head Injury information sheet and Sudden Cardiac Arrest Information sheet.
I have read the WIAA Concussion-SuddenCardiacArrest-InfoSheet2022.pdf. I have had the opportunity to read more information about concussions on the Centers for Disease Control and Prevention’s (CDC) websites.
I understand what a concussion is and how it may be caused. I also understand the common signs, symptoms, and behaviors. I agree that my child must be removed from practice/play if a concussion is suspected. I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me. I understand that my child cannot return to practice/play until they are evaluated by an appropriate health care provider and provides written clearance from the health care provider to the school. I understand concussions can have a serious effect on a young, developing brain and needs to be addressed correctly.
I have read the  WIAA Concussion-SuddenCardiacArrest-InfoSheet2022.pdf. I understand that my child should stop activity/exercise immediately if they have any warning signs of sudden cardiac arrest. I understand it is recommended if my child has any warning signs of sudden cardiac arrest while exercising, they have a medical examination before exercising or returning to participation in their sport.
I understand that I or my child should report a family history of heart problems or warning signs of sudden cardiac arrest to the healthcare provider doing the medical examination.
I understand how to request at my cost the administration of an electrocardiogram, in addition to a comprehensive physical examination required to participate in a youth athletic activity. I understand the athletic director may be able to assist me. *
Concussions and Symptoms/Signs of Concussions *
Please list how many concussions and/or symptoms of concussions. Also list if these were reported to medical personnel.
My child has experienced symptoms of sudden cardiac arrest and has been medically cleared by an appropriate medical provider (on file at school).
 *
Name and Relationship to Student of Emergency Contact #1. This person should also be on file with the district as either a Parent/Legal Guardian or an Emergency Contact. *
Phone Number of Emergency Contact #1: *
Name and Relationship to Student of Emergency Contact #2.  This person should also be on file with the district as either a Parent/Legal Guardian or an Emergency Contact. *
Phone Number of Emergency Contact #2: *
Aspirus Riverview Hospital & Clinics, Inc. Parent/Guardian Authorization/Consent Form for Athletic Trainer Services: Disclosure of Protected Health Information: I understand that my child's personal health information is protected by federal regulations under either Health Information Portability and Accountability Act (HIPAA) or the Family Educational Rights an Privacy Act of 1974 (FERPA) and may not be disclosed without my authorization or consent. I also understand that I am not required to sign this authorization/consent in order for my child to be eligible for participation in school athletics. I understand that my child's protected health information may or could be used by athletic training staff for purposes of providing athletic training and medical services, reporting and providing information, and communications with coaches, administrators, physical therapists, doctors, and other allied health professionals. This authorization will allow athletic trainers to disclose medical information pertaining to my child to coaches, school officials, and athletic directors on a "need to know" basis. This will ensure the safety of my child while participating in sports, as well as establish a communication channel for coaches to stay abreast of my child's playing status and medical condition. Medical information shared between medical providers, coaches, and school administrators is confidential information and will not be shared to those outside of these positions. 
I hereby consent and authorize ARHC's athletic trainers, physical therapists, and other health care personnel to disclose protected health information and any related information regarding an injury or illness during my child's training for, and participation in, athletics to the individuals of entities noted above for the purposed stated. I understand that the local, regional and national media are not covered by HIPAA or FERPA and that these legal requirements will not apply. 
Expiration or Revocation: This authorization/consent expires one year from the end of the participation of my child in athletics. I understand I have the right to revoke authorization at any time by sending written notification to ARHC's Director of Physical Therapy.
 *
Consent for Baseline Cognitive Testing and Release of Information: I give my permission for my child to have baseline ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test administered at Nekoosa High School. I understand that my child may need to be tested more than once, depending upon the results of the test. I understand there is not charge for testing. Nekoosa High School and Aspirus Riverview Hospital and Clinics, Inc. may release the ImPACT test results to my child's primary care physician, neurologist, other treating physician, or any licensed healthcare professional as indicated below. I understand that general information about the test data may be provided to my child's guidance counselor and teachers, for the purposes of providing temporary academic modifications, if necessary. *
Consent for Post-Concussion Cognitive Testing and Release of Information: I give my permission for my child to have Post-Concussion ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) test administered at Nekoosa High School. I understand that my child may need to be tested more than once, depending upon the results of the test, as compared to my child's baseline test, which is on file at Nekoosa High School. I understand there is no charge for testing. Nekoosa High School and Aspirus Riverview Hospital and Clinics, Inc. may release the ImPACT test results to my child's primary care physician, neurologist, other treating physician, or any licensed healthcare professional as indicated below. I understand that general information about the test data may be provided to my child's guidance counselor and teachers, for the purposes of providing temporary academic modifications, if necessary. *
Name of Physician/licensed healthcare professional and Name of Practice/group: *
Phone number for Physician/licensed healthcare professional: *
I authorize medical treatment should the need arise for such treatment while I or my child/ward (“student-athlete”) is under the supervision of the member school. I consent to medical treatment for my student-athlete following an injury or illness suffered during practice and/or a contest. I understand that in the case of injury or illness requiring treatment by medical personnel and transportation to a health care facility, a reasonable attempt will be made to contact me the parent/legal custodian in the case of my student-athlete being a minor, but that, if necessary, my student-athlete will be treated and transported via ambulance to the nearest hospital. I further authorize the use or disclosure of my student-athlete’s personally identifiable health information should treatment for illness or injury become necessary.
I hereby state that the above information is correct and I will hereby notify the school if any chances occur. *
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