2022-2023 Triton Central Middle School Student Athlete Required Forms
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Student First Name *
Student Last Name *
Student Date of Birth *
Make sure to select the correct YEAR.
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YYYY
Student Grade for the 2022-2023 School Year *
Contact Information
Parent First Name *
Parent Last Name *
Parent Phone Number *
Example: 317-555-5555
Parent Email Address *
Street Address *
City *
Zip Code *
Athletic Eligibility
Please take time to read applicable portions of the TCMS Student Handbook here:

https://www.nwshelbyschools.org/o/tcms/page/student-handbook
Parent Required Signature
I, as the Parent or Legal Guardian of the above named student have read the TCMS Student Handbook.  

1.    In accordance with the rules of the IHSAA, I hereby give consent for the named student to participate in the athletic programs at Triton Central Middle School.
2. I acknowledge that the participant is assuming a certain risk of being injured and that even with the best coaching, use of protective equipment and strict observation of rules, injuries are still a possibility in organized athletics.  On rare occasions these injuries can be so severe as to result in total disability, paralysis, or even death.
3.I consent to the disclosure by the school to the IHSAA of all required detailed financial (athletic or otherwise), scholastic and attendance records of the school, including records which may concern or be related to the student, unless the student is emancipated, in which case the student gives such consent.
4. I authorize responsible school personnel or their agents to oversee or provide emergency medical care to the student in the event of serious injury or in the event the parent/guardian cannot be reached in a timely manner.
5.    I authorize the school to investigate and obtain information from police agencies, the probation department or any other source regarding events leading up to any arrest or filing of charges for an act which would be in violation of any of the athletic rules published as part of the student handbook.
6. I have been provided with a copy of the rules and regulations regarding athletic participation or received copies of those rules and regulations in the student handbook.  I understand the rules and regulations and will comply with them as stated.  I understand that the rules and regulations will be in effect for all athletes as long as they are a student at Triton Central Middle School and that the rules and regulations may be updated from time to time.
7.    I understand that Triton Central Middle School has in place a "reasonable suspicion" drug testing policy and that school personnel may order a drug test on the student if reasonable suspicion exists.
8. I authorize Triton Central Middle School to post results/highlights containing my son's/daughter's name on the TCMS websites and social media accounts.

By typing your PARENT NAME below, this is acting as your electronic signature. *
Student Required Signature
I have read the rules and regulations of the Indiana High School Athletic Association (IHSAA) and Triton Central Middle School and believe that I am eligible to represent my school in athletics.  If accepted as a representative, I agree to abide by the rules and regulations of the IHSAA and my school.  To the best of my knowledge, I have suffered no injury or illness in the past that would hinder my participation in my chosen sport(s).
By typing your STUDENT NAME below, this is acting as your electronic signature *
Concussion & Sudden Cardiac Arrest Information
IC 20-34-7 and IC 20-34-8 require schools to distribute information sheets to inform and educate student athletes and their parents on the nature and risk of concussion, head injury and sudden cardiac arrest to student athletes, including the risks of continuing to play after concussion or head injury. These laws require that each year, before beginning practice for an interscholastic sport, a student athlete and the student athlete’s parents must be given an information sheet, and both must sign and return a form acknowledging receipt of the information to the student athlete’s coach.

IC 20-34-7 states that an interscholastic student athlete, in grades 5-12, who is suspected of sustaining a concussion or head injury in a practice or game, shall be removed from play at the time of injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider trained in the evaluation and management of concussions and head injuries, and at least twenty-four hours have passed since the injury occurred.

IC 20-34-8 states that a student athlete who is suspected of experiencing symptoms of sudden cardiac arrest shall be removed from play and may not return to play until the coach has received verbal permission from a parent or legal guardian for the student athlete to return to play. Within twenty-four hours, this verbal permission must be replaced by a written statement from the parent or guardian.

Parent/Guardian - please read the attached fact sheets (links below) regarding concussion and sudden cardiac arrest and ensure that your student athlete has also received and read these fact sheets. After reading these fact sheets, please ensure that you and your student athlete sign this form, and have your student athlete return this form to his/her coach. Electronic Signatures below serve this purpose.

Concussion Fact Sheet: https://www.cdc.gov/headsup/pdfs/highschoolsports/athletes_fact_sheet-a.pdf

Concussion Fact Sheet (Spanish): https://www.cdc.gov/headsup/pdfs/highschoolsports/high_school_sports_athletes_fs_spanish_v2_508.pdf

Concussion Information Sheet: https://www.cdc.gov/headsup/pdfs/youthsports/parent_athlete_info_sheet-a.pdf

Concussion Information Sheet (Spanish):
https://www.cdc.gov/headsup/pdfs/youthsports/esp/parent_athlete_info_sheet_spanish-a.pdf

Middle School Concussion Fact Sheet:
https://www.cdc.gov/headsup/pdfs/highschoolsports/middleschool_athletes_fact_sheet-a.pdf

Middle School Concussion Fact Sheet (Spanish):
https://www.cdc.gov/headsup/pdfs/highschoolsports/middle_school_sports_athletes_fs_spanish_v2_508.pdf

Concussion Fact Sheet for Parents:
https://www.cdc.gov/headsup/pdfs/highschoolsports/parents_fact_sheet-a.pdf

Concussion Fact Sheet for Parents (Spanish):
https://www.cdc.gov/headsup/pdfs/highschoolsports/high_school_parents_fact_sheet_spanish_v3_508.pdf

Sudden Cardiac Arrest Fact Sheet for Parents:
https://www.doe.in.gov/sites/default/files/health/sudden-cardiac-arrest-fact-sheet-parents.pdf

Sudden Cardiac Arrest Fact Sheet for Parents (Spanish):
https://www.doe.in.gov/sites/default/files/health/sudden-cardiac-arrest-fact-sheet-parentsspanish.pdf

Sudden Cardiac Arrest Sheet for Student Athletes:
https://www.doe.in.gov/sites/default/files/health/sudden-cardiac-arrest-fact-sheet-student-athletes.pdf

Sudden Cardiac Arrest Sheet for Student Athletes (Spanish):
https://www.doe.in.gov/sites/default/files/health/sudden-cardiac-arrest-fact-sheet-student-athletesspanish.pdf

Parent Signature
I, as the Parent or Legal Guardian of the above named student(s) have read the Parent Information Fact Sheets on CONCUSSIONS and SUDDEN CARDIAC ARREST. I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury, and the symptoms of Sudden Cardiac Arrest.

By typing your PARENT NAME below, this is acting as your electronic signature *
Student Signature
As a student-athlete, I have received and read the fact sheets regarding concussion and sudden cardiac arrest.  I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury, and the symptoms of sudden cardiac arrest.
By typing your STUDENT NAME below, this is acting as your electronic signature *
Primary Care Physician (Family Doctor) Name *
Primary Care Physician Phone Number *
Example: 317-555-5555
Emergency Contact Information
Please provide the contact information of two individuals not including parent information entered earlier.
Emergency Contact 1- First Name *
Emergency Contact 1- Last Name *
Emergency Contact 1- Primary Phone Number *
Example: 317-555-5555
Emergency Contact 1- Secondary Phone Number
Example: 317-555-5555
Emergency Contact 2- First Name *
Emergency Contact 2- Last Name *
Emergency Contact 2- Primary Phone Number *
Emergency Contact 2- Secondary Phone Number
General Information
Current Medications
List all medications currently being taken.  If no medications are being taken, leave blank.
Allergies
List all allergies currently being taken.  If no allergies, leave blank.
Does your child use an inhaler for asthma? *
If YES- Will the inhaler need to be obtainable at practices and games?
If NO- Do not answer.
Clear selection
Does your child use an epi-pen? *
If YES- Will the epi-pen need to be obtainable at practices and games?
If NO- Do not answer.
Clear selection
Parent Consent
I hereby authorize the athletic staff of NWCSD to administer any emergency medical treatment of my son/daughter should they become injured while participating in an athletic event.  Included in this consent is permission to transport and treat in route to a medical facility should the injury be serious in nature.
By typing your PARENT NAME below - this is acting as your electronic signature *
IHSAA Physical Form
A documented Physical Assessment is REQUIRED BEFORE any TCMS student takes part in athletics tryouts, practices, or competition during the 2022-2023 school year. Any physical dated after April 1, 2021 will be accepted.  For a copy of the IHSAA Physical Assessment form, visit the TCMS Office or https://www.ihsaa.org/Portals/0/ihsaa/documents/quick%20resources/Physical%20Form.pdf
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