Student-Athlete Participation Form

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Twinfield-Cabot Athletics

Student's Name *

Student's School Email Address *

Student's Cell Phone Number

Student's Age as of September 1, 2022 *

Student's Grade Level as of September 1, 2022 *

6th

7th

8th

9th

10th

11th

12th

1. Parent/Guardian Name *

1. Parent/Guardian Email *

1. Parent/Guardian Cell Phone Number *

2. Parent/Guardian Name

2. Parent/Guardian Email

2. Parent/Guardian Cell Phone Number

I confirm that my son/daughter is enrolled as a full-time student at Twinfield Union, Cabot School, or lives within the supervisory district. (Home study students require documentation from the State of Vermont Agency of Education PRIOR to beginning any activity; please contact the Athletic Director for more information.) I give permission for my son/daughter to participate in the following school approved interscholastic athletic activities (except those prohibited by an examining physician).
*

Middle School (6 - 8) Cross Country

Middle School (6 - 8) Soccer

Middle School (6 - 8) Basketball

Middle School (6 - 8) Softball/Baseball

Varsity Cross Country

Varsity Soccer

Varsity Basketball

Varsity Softball/Baseball

Required

Families must agree to the terms below by checking all four boxes before their child is allowed to participate in the Twinfield-Cabot Athletic Program.

I understand that Twinfield Union and Cabot School will not accept responsibility for any payment, co-payment, deductible or related expenses.

I understand that all costs associated with medical care, emergency medical transportation, medication, rehabilitation or therapeutic treatment must be paid through my child's health and accident insurance carrier.

I grant permission for school personnel to secure medical treatment for my child in the event of an emergency.

I understand that I must submit an updated Well Child Form before my child can participate.

Required

Insurance Carrier Name, Group Number, and Policy Number *

Additional Consent and Agreements *

I give permission for my child's photo and video images to be used on the twinfieldcabot.team website and promotional materials

I understand the signs and symptoms, treatment, and prevention of concussions as part of Vermont Law Act 58.

I understand that uniforms are property of the Twinfield-Cabot Athletic program and if not returned or returned damaged, I will be charged the replacement cost for the item(s).

Required

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