REGISTRATION FORM WINTER 2021-2022
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TAHANTO REGIONAL WINTER ATHLETICS REGISTRATION  2021-2022                                                                                           (The deadline for registration is November 22, 2021)
Please complete the following form and submit.  Please note that in addition to this form your son/daughter must have had a physical exam on file in the nurses office.  The physical is valid for 13 months from the date of the physical (physicals dated before OCTOBER 29, 2020 would be considered expired).   All students must have a valid physical in order to participate in the athletic program.  User fees for the winter sports  must be paid at the time of registration (EXCEPT FOR MS BOYS BASKETBALL; THEIR FEES WILL BE DUE ONCE THE TEAM IS PICKED BY DECEMBER 10).


I have read and understand the policies and procedures as set forth in the Athletic Handbook (at www.bbrsd.org) and agree to abide by these policies and procedures.  I understand that the Tahanto Regional Administration and Athletic Department reserve the right to address any situation not specifically covered in the handbook in a manner that is deemed to be in the best interest of the student-athlete and Tahanto Regional as a whole.

I, the undersigned parent/guardian of the listed student, a minor, do hereby consent to my (student’s name) child’s participation in voluntary athletic or recreation programs sponsored by the Berlin-Boylston Public Schools. I agree to forever release, acquit, discharge, indemnify, defend, and covenant to hold harmless the Berlin-Boylston Public Schools, the School Committee, and all their employees, agents, board members, volunteers and any and all individuals and organizations assisting or participating in voluntary athletic or recreation programs of the Berlin-Boylston Public Schools (together the “Releasees”) from any and all claims, rights of action and causes of action that I may have and which have arisen in the past, or may arise in the future, directly or indirectly, from any known and unknown personal injuries to my child or property damage resulting from my child’s participating in the Berlin-Boylston Public Schools’ voluntary athletic or recreation programs. I also agree to forever release, acquit, discharge, indemnify, defend, and covenant to hold harmless the Releasees from any and all claims, rights of action and causes of action that my minor child may have or hereafter may acquire, either before or after reaching the age of majority which have arisen in the past, or may arise in the future, directly or indirectly, from any known or unknown personal injuries to my child or property damage resulting from my child’s participating in the Berlin-Boylston Public Schools’ voluntary athletic or recreation programs. I further affirm that I have read this Consent and Release Form and that I understand the contents of the Form. I understand that my child’s participation in these programs is voluntary and that my child and I are free to choose not to participate in said programs. By submitting this Form, I affirm that I have decided to allow my child to participate in the Berlin-Boylston Public Schools’ programs with full knowledge that the Releasees will not be liable to anyone for personal injuries and property damage my child or I may suffer in voluntary Berlin-Boylston Public Schools’ athletic or recreation program.


ATHLETIC FEE PAYMENT & ATHLETIC FEE WAIVERS
Before you are able to register you MUST pay the athletic fee at the Online Payment Center located under "Links" below this section (UNLESS THE STUDENT IS TRYING OUT FOR MS BOYS BASKETBALL OR ICE HOCKEY AT HUDSON)  You will need the confirmation number to complete this form.  If you are applying for a partial waiver you must fill out the Athletic Fee Waiver form AND pay the partial waiver at the Online Payment Center before registering.  Any student on free/reduced lunch should check off the Free/Reduced lunch box AND submit the athletic fee waiver form

 
LINKS
ATHLETIC FEE WAIVER FORM:   https://forms.gle/XfNDRs5WsZkaJxoa9

ONLINE PAYMENT CENTER:   Select Berlin-Boylston RSD under the search box at website  https://unipaygold.unibank.com/customerinfo.aspx
ATHLETIC FEE PAYMENT *
WHAT IS THE ATHLETIC FEE CONFIRMATION NUMBER. (This number is obtained from the on-line payment center.  If you are applying for a full waiver, type in WAIVER for the number.  If registering for MS Boys Basketball type in MSBoys; for Ice Hockey type in HOCKEY) *
What is the amount of your payment for this student?                                                                  (Do NOT include check fees or charge card fees).  (MS Boys basketball candidates and Ice Hockey candidates type 0) *
Students First Name *
Students Last Name *
Grade *
Parent/Guardian First Name *
Parent/Guardian Last Name *
Street *
Sport  (Sign up for one only) *
6th and 7th graders must sign up for MS team in sport where a MS team is offered.  If there isn't a sufficient number of students to run an individual program, the program will not run and your money will be refunded.
Town/City *
Zip Code *
Home Phone *
Work Phone
Cell phone
Emergency Contact *
In case parent is not home or available
Emergency Contact Phone Number *
Any medical conditions you wish the coach to be aware of? *
(Example: Allergies, asthma, etc      If none type "NONE" )
Has student ever experienced a traumatic head injury (a blow to the head) or received medical attention for a head injury? *
If yes please describe the dates (month/year) of the injury and the circumstances as well as any medical treatment
Has student ever been diagnosed with a concussion? *
If yes, please indicate the dates (month/year) and the duration of symptoms such as headache, difficulty concentrating, fatigue, etc for the most recent concussion)
Parent Guardian: I have been provided education regarding concussions AND Opiate Misuse.   If not STOP, and go back to the main ATHLETICS page and download the 'Guide to Concussions' and "Opiate Misuse" in the Quicklinks on the athletic web site *
Required
Student-Athlete: I have been provided education regarding concussions AND opaite misuse.  If not STOP, and go back to the main ATHLETICS page and download the 'Guide to Concussions' and/or "Opiate Misuse" in the Quicklinks of the athletic web site *
Required
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A copy of your responses will be emailed to the address you provided.
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