Step 3: Athletic Eligibility Form



 
YOU MUST FILL OUT THE CHECKLIST FOR STUDENT ELIGIBILITY 
     
     
     
     
     
     
     
     
     
     
     
     
     
 

 REFUND POLICY - 
1. When injury or illness prevents continuation in the activity, a refund will be made (provided the injury or illness is substantiated by a physician's statement) up until the time of the first contest, or after 10 days which ever occurs first.
2. When a transfer is made out of Granite School District up until the first contest.
3.  NO refunds will be award for a students who quits an activity, dismissed from an activity because of disciplinary reasons or eligibility infractions.
4.  NO refunds will be given after the first 10 days or first contest, whichever comes first.
5.  Please fill out a Refund Request form, and return it to the Activities Coordinator for a refund.

Athletes must turn in:

  • MSHSL Eligibility form  -  once per school year
  • Coaches Emergency Information Card - must be turned in each season
  • Fee Payment
  • Current Sports Qualifying Physical Examination must be on file in Activities Office. ALL forms must be completed and returned to the Activities Office before the athlete can participate in a team practice and/or tryout.
 

 

Student/Participant Information:
 
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 List All Schools Enrolled in During the Following School Years:
 
 
 
 
 
 
 
 
 

 Parent/Guardian 1 Information:
 
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 Parent/Guardian 2 Information:
 
 
 
 
 
 
 
 
 

 
 
ANSWER THE FOLLOWING as YES or NO 'Since the student's last Sports Qualifying Physical Exam or Sports Health Questionaire' (I.E. If last physical was last month then answer these questions AS OF the date of the physical last month):
 

Check off any boxes where the answer is YES.
 
     
 

IMPORTANT HEART HEALTH QUESTIONS ABOUT YOU
 
     
     
     
     
     
 

IMPORTANT HEART HEALTH QUESTIONS ABOUT YOUR FAMILY
 
     
     
     
     
     
     
 

MEDICAL RISK QUESTIONS
 
     
     
     
 
 
Parents or Legal Guardians - please note:
• A “Yes” answer to any of the above questions will require a clearance note from a physician prior to participation.
 
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 2012-2013 MSHSL Athletic Eligibility Statement

• I have read, understand, and acknowledge receiving the 2012-2013 Athletic Eligibility Brochure, which contains a summary of the eligibility rules of the Minnesota State High School League. I understand that a copy of the Official Handbook of the MSHSL is on file with the senior high school athletic director and/or principal and that I may review it, in its entirety, if I so choose. The Official Handbook and MSHSL bylaws are also posted on the MSHSL Web site: www.mshsl.org in the Resources/Publication/Eligibility section for my review.

*We, the student and parent, have reviewed Concussion Management Recommendations for MSHSL Athletes contained in Eligibility Brochure and on the following website: www.cdc.gov/concussion

• I understand that once I sign the eligibility statement all eligibility rules apply:

- Twelve (12) months of the year;
- Whether I am currently participating or not;
- Continuously from the first signing of this statement through the completion of my high school eligibility.

* Regardless of my age I agree to follow all of the MSHSL Bylaws in order to be eligible to represent my school in League-sponsored activities.

• I further understand that a member school of the MSHSL must adhere to all of the rules and regulations that pertain to the League athletic activities a school may sponsor and that local rules may be more stringent, and penalties more severe, than MSHSL rules.

STUDENT CODE OF RESPONSIBILITIES
• As a student participating in my school’s interscholastic activities, I understand and accept the following responsibilities:

- I will respect the rights and beliefs of others and will treat others with courtesy and consideration.
- I will be fully responsible for my own actions and the consequences of my actions.
- I will respect the property of others.
- I will respect and obey the rules of my school and the laws of my community, state and country.
- I will show respect to those who are responsible for enforcing the rules of my school and the laws of my community, state and country.
A student whose character or conduct violates the Student Code of Responsibilities or is suspended or expelled is not is not in good standing and is ineligible for a period of time as determined by the principal. While a student not in good standing, a student may not serve any penalty or MSHSL bylaw violations.

• Informed Consent: By its nature, participation in interscholastic athletics includes risk of injury and the transmission of infectious diseases such as HIV, Herpes Hepatitis B and others. Although serious injuries are not common and the risk of HIV transmission is almost nonexistent in supervised school athletic programs, it is impossible to eliminate all risk. Participants have the responsibility to help reduce that risk. Participants must obey all safety rules, report all physical and hygiene problems to their coaches, follow a proper conditioning program, and inspect their own equipment daily. PARENTS, GUARDIANS OR STUDENTS WHO MAY NOT WISH TO ACCEPT THE RISK DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS FORM. STUDENTS MAY NOT PARTICIPATE IN A MSHSL-SPONSORED ACTIVITY WITHOUT THE STUDENT’S AND PARENT’S/GUARDIAN’S SIGNATURE.

• I consent to the athletic trainer or coach treating injuries and authorize them to discuss those injuries with and release any applicable medical information or records relating to those injuries to coaches, school staff and other qualified health care providers as deemed necessary within their scope of practice. I further understand that in the case of injury or illness requiring transportation to a health care facility, that a reasonable attempt will be made to contact the parent or guardian in the case of a student-athlete being a minor, but that, if necessary, the student-athlete will be transported via ambulance to the nearest hospital.

*By signing this we acknowledge that we have read the information contained in the MSHSL Eligibility Brochure and Statement.

The student/parent authorizes the release of documents and other pertinent information by the school in order to determine student eligibility. In addition, the student/parent understands and agrees that public information shall include names and pictures of students participating in or attending extra-curricular activities, school events, and High School League activities or events.

 
 I do not know of any existing physical or additional health reason that would preclude participation in sports. I acknowledge that I have read the Athletic Eligibility Brochure and Statement. I certify that the answers to the above questions are true and accurate and I approve participation in athletic activities.

 
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 I/we acknowledge the electronic signature confirms i/we have read and reviewed the information contained in the contents of the Eligibility Brochure and Statement.  I/we also acknowledge this electronic signature has the same legal effect, validity, and enforceability as a signature in a non-electronic form.
 




  Send a copy of the completed form to this email address : 


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