ATHLETIC CHECK FORM
Welcome!
In order to begin participating in Sports at the BREWSTER MIDDLE or HIGH SCHOOL we require the following items be completed/turned in:

1. Student Information
2. Parent Information
3. Emergency Contact Information
4. Updated Sports Physical
5. HS ASB Card ($50.00)
6. Read/Acknowledged Student/Athlete Handbook

*Failing to complete/turn-in all the requested information, will keep you INELIGIBLE to practice or play!

*Completing all required information, will CLEAR you to begin practice, and ELIGIBLE to play!

FOR MORE INFORMATION:

*Parents & Students, please follow these instructions when submitting your Athletic Check form.
**You must complete all the (*)steps before the Athletic Check form can be submitted and reviewed, by your building Secretary.

**Extra-Curricular Handbook:
https://docs.google.com/document/d/11lxVyBu803781eRNMJUzYke_s1TlfLnk/edit?usp=sharing&ouid=117120490145355947986&rtpof=true&sd=true

If you have any questions, regarding this form... Please contact your building Secretary:

Middle School Secretary- Maggie Ochoa (mochoa@brewsterbears.org) 509.689.3440 ext. 3101

High School Secretary- Mayra Pamatz (mpamatz@brewsterbears.org) 509.689.3449 ext. 4411

Thank you.
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***ASB CARD***
PLEASE MAKE SURE TO PURCHASE YOUR ASB CARD AT THE HS OFFICE. 
ASB CARDS ARE $50.00/ ATHLETE
ATHLETIC ELIGIBILITY IS FOR HIGH SCHOOL STUDENTS ONLY. 
***SPORTS PHYSICAL***
PLEASE MAKE SURE TO TURN IN A COPY OF AN UPDATED SPORTS PHYSICAL TO THE MS/HS OFFICE.
*SPORTS PHYSICALS ARE only ACTIVE FOR 13 MONTHS*

-IF YOU WOULD LIKE TO KNOW OF YOUR LAST PHYSICAL STATUS(DATE)...PLEASE ASK THE OFFICE SECRETARIES TO LOOK ON SKYWARD-
***STUDENT INFORMATION***
PLEASE FILL OUT ALL THE FOLLOWING INFORMATION... ANY MISSED OR INCORRECT INFORMATOIN WILL NOT ALLOW FOR ON-TIME SPORTS CLEARANCE: PLLEASE SEE THE HIGH SCHOOL OFFICE, IF YOU HAVE ANY QUESTIONS.
STUDENT FULL NAME: (FIRST, MIDDLE, LAST) *
STUDENT BIRTHDATE: (MONTH, DAY, YEAR) *
MM
/
DD
/
YYYY
STUDENT GENDER: *
Required
HOME ADDRESS: ( #, STREET, CITY) *
GRADE: *
SPORT: PLEASE SELECT THE SPORT(S) IN WHICH YOU PLAN ON PARTICIPATING: *
Required
***PARENT/ GUARDIAN(S) INFORMATION: PLEASE MAKE SURE A PARENT/GUARDIAN FILLS OUT ALL THE FOLLOWING INFORMATION***
PARENT/GUARDIAN(1) FULL NAME: *
PARENT/GUARDIAN (1) PHONE NUMBER *
PARENT/GUARDIAN (1) EMAIL: (IF ANY)
PARENT/GUARDIAN (2) FULL NAME:
PARENT/GUARDIAN (2) PHONE NUMBER:
PARENT/GUARDIAN (2) EMAIL: (IF ANY)
LIVING WITH? *
EMERGENCY CONTACT (1) NAME: *
EMERGENCY CONTACT (1) PHONE NUMBER: *
EMERGENCY CONTACT (2): NAME
EMERGENCY CONTACT (2): PHONE NUMBER
***PLEASE READ THE FOLLOWING INFORMATION BELOW***
**RULES/REGULATION AGREEMENT**
BY TYPING YOUR FULL NAME BELOW: YOU AGREE TO FOLLOW ALL RULES/REGULATIONS THAT ENCOMPASS THE PARTICIPATION OF SCHOOL SPORTS AT THE BREWSTER SCHOOL DISTRICT.  

IF YOU FAIL TO FOLLOW THE STATED RULES/REGULATIONS, THEN YOU FACE THE EXPULSION OF PARTICIPATING AT ANY POINT DURING THE SPORTS SEASON.

IF YOU HAVE ANY QUESTIONS, PLEASE FEEL FREE TO CONTACT THE DISTRICT ATHLETIC DIRECTOR; Greg Austin, gaustin@brewsterbears.org 509.689.3440 ext. 3102

Thank you.  
***STUDENT-PARENT-GUARDIAN WARNING***
It is the school district's intent to provide any athlete with good instruction, safe equipment, and safe transportation; but we cannot eliminate all risks involved in sports participation. ACCIDENTAL INJURY, COMPLETELY UNRELATED TO ANY PREVENTABLE CAUSE IS ALWAYS POSSIBLE.

This ASSUMPTION OF RISK form is designed to provide this school district with a degree of protection. It is not designed to deny the rights of any injured athlete. OUR SCHOOL DISTRICT PROVIDES CATASTROPHIC MEDICAL INSURANCE COVERAGE TO PARTICIPATING STUDENTS. Participation in WIAA sponsored interscholastic activities is voluntary and extracurricular. As a condition to participation in these activities, you and your parents/guardians must understand the risks involved in these kinds of activities.

"WARNING" Participation in any athletic activity may involve injury of some type to either yourself or a fellow student athlete. Such injury can include direct physical and possible crippling injury to one's body and the possibility of emotional injury experienced as a result of witnessing or actually inflicting injury to another. The severity of such injury can range from minor to catastrophic injury such as complete paralysis or even one's future ability to earn a living, to engage in another business, social and recreational activities, and generally to enjoy life.

Activity injuries can result from the incorrect or correct performance of playing techniques used in try-outs, practices, warm-ups, games, drills, exercises and other similar undertakings. Injury can also result from failing to follow game, training, safety or other team rules. Injury can result from the use of transportation provided or arranged by the school district to and from the interscholastic activity.

Therefore, the purpose of this WARNING is to aid you in making an informed decision as to whether you/your child or ward should participate in these activities. In addition, its purpose is to make you aware that as a student participant, or as a parent or guardian of a student participant, it is your responsibility to learn about and/or inquire of coaches, physicians, advisors or other knowledgeable persons about any concerns that you might have at any time regarding participant's safety.
DO YOU AGREE WITH THE STUDENT-PARENT-GUARDIAN WARNING? *
***DRUG/ ALCOHOL/ TOBACCO AGREEMENT***
No individual participating in any extra-curricular activities will be allowed to associate with, use, distribute or be in possession, including possession by consumption, of any non-prescription drug, alcohol, or tobacco. This policy is in effect 24 hours a day, throughout the WIAA school year and is cumulative throughout the participant’s career.
Participants and their legal parent/guardian must sign and turn in the Drug/Alcohol/Tobacco Agreement to the Activities Director in order to be eligible to practice or participate in any extra-curricular activity.

1. First Offense: A student found in violation of the Drug/Alcohol/Tobacco rule will be suspended from competition for a period of four (4) weeks.
Before the student is eligible to participate in any other activity, he/she must complete six (6) hours of an approved and appropriate substance abuse counseling program. The student is responsible for the cost of counseling.

2. Second Offense: A student found in violation of the Drug/Alcohol/Tobacco rule for a second time, will be suspended from competition for a period of one (1) calendar year from the time of the infraction. Before the student is eligible to participate in any other activity, he/she must complete six (6) hours of an approved and appropriate substance abuse counseling program. The student is responsible for the cost of counseling.

3. Third Offense: A student found in violation of the Drug/Alcohol/Tobacco rule for a third time, will be suspended from participation in any school activity for the remainder of their high school career.
DO YOU AGREE TO FOLLOW THE DRUG/ ALCOHOL/ TOBACCO AGREEMENT? *
***MEDICAL EMERGENCY AUTHORIZATION***
As Parent or Legal Guardian, I authorize the team physician or, in his absence, a qualified physician to examine the above-named student and in the event of injury to administer emergency care and to arrange for any consultation by a specialist, including a surgeon, he deems necessary to insure proper care of any injury.

Every effort will be made to contact parent or guardian to explain the nature of the problem prior to any involved treatment.
MEDICAL INSURANCE CARRIER: *
MEDICAL INSURANCE POLICY # : *
PARENT/GUARDIAN SIGNATURE: *
STUDENT SIGNATURE: *
***NEED ASSISTANCE? ***
IF YOU HAVE ANY QUESTIONS, COMMENTS OR CONCERNS REGARDING THIS FORM...

PLEASE FEEL FREE TO CONTACT THE MS OR HIGH SCHOOL OFFICE:
MAGGIE OCHOA ext. 3101 / MAYRA PAMATZ ext. 4411
MOCHOA@BREWSTERBEARS.ORG / MPAMATZ@BREWSTERBEARS.ORG

For more information, regarding the Extra-Curricular Handbook: (click the link below)
https://docs.google.com/document/d/11lxVyBu803781eRNMJUzYke_s1TlfLnk/edit?usp=sharing&ouid=117120490145355947986&rtpof=true&sd=true

THANK YOU.

GREG AUSTIN (ATHLETIC DIRECTOR)
GAUSTIN@BREWSTERBEARS.ORG
509.689.3440 EXT. 3102
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