Hill Athletic Participation Agreement

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Parents/guardians complete a form for each athlete participating in athletics at Hill Middle School. Please provide an email address below to receive a confirmation of completion and a copy of our athletic code of conduct, concussion waiver, and our school policies that all athletes must follow for the duration of the season.

Email *

Sport *

First Name (Student) *

Last Name (Student) *

Grade *

7th Grade

8th Grade

Street Address *

City/ZIP *

Parent/Guardian Full Name *

Parent/Guardian Cell Phone *

Optional 2nd Cell Phone

Emergency Contact *

Emergency Contact Phone *

Electronic Required Documents

Is a current physical exam on file with the school nurse? *

All students trying out/practicing for a sport must have a current physical exam on file with the school nurse. A current physical exam is one that has been completed within THIRTEEN months of the last day of the season. Physicals are valid for one calendar year.

Yes

Not Yet, but we are working on it

Medical concerns to be shared with the coaches.

If your child has an inhaler, they are required to have it with them at practice at all times

Is your student covered under a school insurance policy? *

Yes

No, See below

If not, your digital signature constitutes a waiver and a confirmation of other insurance coverage. Either home or school medical insurance is required.

Please include the insurance company and the policy number:

Hill Middle School Athletic Code of Conduct *

Parent/Guardian and athletes are asked to and read the following guidelines and submit an electronic commitment to your school, administrators, and coaches. In doing so, you are acknowledging that you have read and will comply with these guidelines and policies. Click on the link to view the athletic code of conduct: https://goo.gl/fH92n4

Yes, I have reviewed the following athletic code of conduct and I acknowledging that I have read and will comply with these guidelines and policies.

Concussion From Acknowledgment *

Click the follow link for the district concussion policy and read through the material. In doing so, you are acknowledging that you have read and will comply with these guidelines and policies. https://goo.gl/s81CRj

Yes, I have reviewed the following Concussion Sign Off Form and I acknowledging that I have read and will comply with these guidelines and policies.

Other:

Additional Statements

I understand that I am responsible for transportation to and from school in the event that we are in-person. *

Yes, I understand

Athletic Fees ($125.00 per sport)

Athletes are asked to pay a $125.00 fee per sport/camp
1. Pay the $125 fee for this sport online through PushCoin Webstore (click for instruction https://goo.gl/GDMKjn).
2. Pay by check (payable to Hill Middle School with your phone number and the student's ID#)
3. Pay with cash

Should you have any questions or concerns, please contact our main office.
Deana Gilbert (630)428-6212 deana_gilbert@ipsd.org

Digital Signature of Parent/Guardian - Please type in the first and last name of the parent/guardian that is filling out this form. This constitutes written permission to participate in the Middle School Athletic Program and understanding of the inherit risk involved. *

While participation in athletics provides student athletes with valuable and constructive experiences of both a social and physical nature, it must be remembered and understood normal participation in games and practices may also bring the possibility of serious injury. While every precaution is taken to safeguard athletes from injury, a certain amount of risk is inherent in athletic participation

A copy of your responses will be emailed to the address you provided.

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