NTCS Cross Country Registration Form
Please complete the following as soon as possible. Contact jloween@ntcschool.org with questions.
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Student's Name *
First and last name
Grade Enrolling in for 2021-2022
Clear selection
I have read, understand, and acknowledge receiving the MSHSL Eligibility Brochure, which contains only a summary of the eligibility rules of the Minnesota State High School League. I understand that a copy of the Official Handbook of the MSHSL is on file with the senior high school athletic director and or principal and that I may review it, in its entirety, if I so choose. The Official Handbook and MSHSL bylaws are also posted on the MSHSL Web site: whttps://www.mshsl.org/about/mshsl-handbook.* I have read, understand, and acknowledge receiving the MSHSL Eligibility Brochure *
Required
Concussion Management We, the student and parent, have reviewed Concussion Management Recommendations for MSHSL Athletes contained in the Eligibility Brochure and on the following website: www.cdc.gov/headsup* We, the student and parent, have reviewed Concussion Management Recommendations *
Required
Duration of Eligibility I understand that once I sign the eligibility statement all eligibility rules apply: - Twelve (12) months of the year; - Whether I am currently participating or not; - Continuously from the first signing of the statement through the completion of my high school eligibility.* I understand the Rules for Duration of Eligibility *
Required
MSHSL Bylaws and Rules Regardless of my age I agree to follow all of the MSHSL Bylaws in order to be eligible to represent my school in League-sponsored activities.* I agree to follow all of the MSHSL Bylaws *
Required
I further understand that a member school of the MSHSL must adhere to all of the rules and regulations that pertain to the League athletics/activities a school may sponsor and that local rules may be more stringent, and penalties more severe, than MSHSL rules.* I understand that a member school of the MSHSL must adhere to all of the rules and regulations that pertain to the League athletics/activities. *
Required
Student Code of Responsibilities As a student participating in my schools interscholastic activities, I understand and accept the following responsibilities: - I will respect the rights and beliefs of others and will treat others with courtesy and consideration. - I will be fully responsible for my own actions and the consequences of my actions. - I will respect the property of others. - I will respect and obey the rules of my school and the laws of my community, state and country. - I will show respect to those who are responsible for enforcing the rules of my school and the laws of my community, state and country. - A student whose character or conduct violates the Student Code of Responsibilities or is suspended or expelled is not in good standing and is ineligible for a period of time as determined by the principal. While a student not in good standing, a student may not serve any penalty for MSHSL Bylaw violations.* I understand and accept the MSHSL Student Code of Responsibilities. *
Required
Informed Consent: By its nature, participation in interscholastic athletics includes risk of injury and the transmission of infectious diseases such as HIV, Herpes and Hepatitis B and others. Although serious injuries are not common and the risk of HIV transmission is almost nonexistent in supervised school athletic programs, it is impossible to eliminate all risk. Participants have the responsibility to help reduce that risk. Participants must obey all safety rules, report all physical and hygiene problems to their coaches, follow a proper conditioning program, and inspect their own equipment daily. PARENTS, GUARDIANS OR STUDENTS WHO MAY NOT WISH TO ACCEPT THE RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS FORM. STUDENTS MAY NOT PARTICIPATE IN AN MSHSL-SPONSORED ACTIVITY WITHOUT THE STUDENTS AND PARENTS/GUARDIANS SIGNATURE.* I understand and accept the Informed Consent Statement above: *
Required
Authorization for Treatment of Injuries I consent to the athletic trainer or coach treating injuries and authorize them to discuss those injuries with and release any applicable medical information or records relating to those injuries to coaches, school staff and other qualified health care providers as deemed necessary within their scope of practice.* I authorize the treatment of injuries and release of medical information as stated above *
Required
Authorization to Transport I further understand that in the case of injury or illness requiring transportation to a health care facility, that a reasonable attempt will be made to contact the parent or guardian in the case of the student-athlete being a minor, but that, if necessary, the student-athlete will be transported via ambulance to the nearest hospital.* I understand and accept the Authorization of Transportation statement above: *
Required
* By signing this we acknowledge that we have read the information contained in the MSHSL Eligibility Brochure and Statement.* I/we acknowledge the electronic signature confirms I/we have read and reviewed the information contained in the contents of the Eligibility Brochure and Statement. I/we also acknowledge this electronic signature has the same legal effect, validity, and enforceability as a signature in a non-electronic form. *
Required
* We have read and agree to abide by all that is written in the NTCS Cross Country Handbook (Link to read: https://docs.google.com/document/d/1BjCLu2jHU_XSvXFfhsnf4yD8xGxOUaVpnQhYiEmnw5A/edit?usp=sharing) *
Required
Parent Signature *
Student Signature *
Student is a homeschool student *
Student is a non-NTCS student, requesting a co-op agreement to be signed between his/her school of enrollment and NTCS *
Over the past two weeks, how often have you [the student] been bothered by feeling nervous, anxious, or on edge? *
0-Not at all
3-Nearly every day
Over the past two weeks, how often have you been bothered by not being able to stop or control worrying? *
0-Not at all
3-Nearly every day
Over the past two weeks, how often have you been bothered by little interest or pleasure in doing things? *
0-Not at all
3-Nearly every day
Over the past two weeks, how often have you been bothered by feeling down, depressed, or hopeless? *
0-Not at all
3-Nearly every day
If the sum of responses to questions 1 and 2, or 3 and 4 are greater than or equal to 3, please see your provider.
* In the last year, has a doctor restricted your participation in sports for any reason without clearing you to return to sports? *
* In the last year, have you passed out or nearly passed out during or after exercise? *
* In the last year, have you had discomfort, pain, tightness, or pressure in your chest during exercise? *
* In the last year, does your heart race or skip beats (irregular beats) during exercise? *
* In the last year, do you get light-headed or feel more short of breath than expected during exercise? *
* In the last year, have you had an unexplained seizure? *
* In the last year, has anyone in your immediate family died suddenly and unexpectedly for no apparent reason? *
* In the last year, has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 35 (including an unexplained drowning, or an unexplained car accident)? *
* In the last year, has anyone in your immediate family had instances of unexplained fainting, seizures, or near drowning? *
* In the last year, has anyone in your immediate family been diagnosed with hypertrophic cardiomyopathy, Marfan Syndrome, arrhythmogenic right ventricular cardiomyopathy, long or short QT Syndrome, Brugada Syndrome, or catecholaminergic polymorphic ventricular tachycardia? *
* In the last year, has anyone in your immediate family under age 35 had a heart problem, pacemaker, or implanted defibrillator? *
* In the last year, have you had a head injury or concussion that still has symptoms like continuing headaches, concentration problems or memory problems? *
I do not know of any existing physical or additional health reason that would preclude participation in sports. I certify that the answers to the above questions are true and accurate and I approve participation in athletic activities. *
Parent/Guardian #1 Cell Phone *
Parent/Guardian #1 email address *
Parent/Guardian #2 Cell Phone
Parent/Guardian #2 email address
* If emergency treatment is required, and the parents cannot be reached immediately, may the school authorities use their own judgement in calling the above named doctor or dentist? *
If no, what do parents want done?
COVID-19 NOTICE - PLEASE READ CAREFULLYIn accordance with governmental directives, the MSHSL will offer certain activities subject to compliance with local, state, and federal laws, regulations, and guidelines. The Minnesota Department of Health, Minnesota Department of Education and the MSHSL have developed guidance and requirements related to youth sports, use of school facilities and modifications of MSHSL activities designed to keep participants safe and reduce the spread of COVID-19.Even with these measures, the MSHSL cannot guarantee that students or other individuals participating in organized athletic activities ("Participants") will not be exposed to COVID-19. Participants and their parents/legal guardians should consider the risks before participating in any MSHSL activities. It is a shared responsibility to protect everyone from COVID-19 and Participants should follow MDH/CDC guidelines to reduce the risk of exposure, including but not limited to the following:Stay home as much as possible*Stay at least 6 feet from other people if you are in public places*Avoid close contact with people who are sick*Wash your hands often, with soap and water. Wash for at least 20 seconds*Always wash your hands after being in a public place*Always wash your hands after blowing your nose, coughing, or sneezing*If soap and water are not available, use hand sanitizer that is at least 60% alcohol*Cover your mouth and nose when you cough or sneeze. Cough or sneeze into your elbow or a tissue. Throw used tissues in the trash*Wear face coverings/masks that cover your nose and mouth and fit snugly against the sides of your face.In recognizing the serious nature of the COVID-19 pandemic and the positive impact that participation in MSHSL fine arts activities and athletics has on student participants, it is imperative that students and families know and understand the following: 1. Participating in MSHSL activities is voluntary. 2. While participating in MSHSL activities, all laws as well as MSHSL and school rules, guidelines, and protocols related to COVID-19 must be followed. 3. Participant acknowledges the contagious nature of COVID-19, and the Participant understands that there is risk of injury and/or illness from participating in MSHSL activities, including the risk to have direct or indirect contact with individuals who have been exposed to and/or diagnosed with COVID-19. 4. Participant agrees that if he/she is exposed to, or infected by, COVID-19 during the period of participation, they will immediately cease participation and follow Minnesota Department of Health protocols for schools and activities and MSHSL guidelines for notification and return to participation. 5. Participant has signed a separate Eligibility Statement connected to general participation in MSHSL athletics/activities and agrees that the terms of that statement are wholly incorporated into this document and that the terms of this document are incorporated into the Eligibility Statement. *
Parent/Guardian acknowledges and agrees to COVID notice. *
Emergency Contact #1  Name *
Emergency Contact #1  Relationship to Student *
Emergency Contact #1  Phone Number *
Emergency Contact #2 Name *
Emergency Contact #2 Relationship to Student *
Emergency Contact #2 Phone Number *
Medical Provider *
Dr. Name *
Dr. Phone Number *
Dentist Name *
Dentist Phone Number
Athletics fee per sport is $125. Please pay by check, cash or online via your Gradelink account. (Scholarships available up on request. Send request to jloween@ntcschool.org)
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Uniform top size (in men's and women's sizes) *
Uniform bottom size (in men's and women's sizes) *
Complete registration by ticking the checkbox below, this sends the form to Jaci Loween for approval. (Also hit the submit button below.) Form will be approved when athletics fee has been paid. *
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