AUC Athletics Registration Form

Please fill out one registration form per child

Student's First Name

Student's Last Name

Gender

M F

Birthday

Address

City

ZIP

Grade Level

Parent/Guardian’s Full Name (1)

Parent/Guardian (1) Tel

Parent/Guardian Email (1)

Parent/Guardian’s Full Name (2)

Parent/Guardian Tel (2)

Parent/Guardian Email (2)

REQUIREMENTS FOR STUDENT-ATHLETE’S ELIGIBILITY

Signed Registration Form
Good academic & behavioral standing
Primary Insurance covering the athlete

PRE-PARTICIPATION PHYSICAL EVALUATION FORM

Please download and fill THIS FORM in order to proceed.
The Physical Evaluation Form should be completed and signed by a licensed physician, licensed osteopathic physician, licensed chiropractic physician, licensed physician assistant, or certified advanced registered nurse practitioner.
The 1st page of the Physical Evaluation Form (Medical History) should be completed by the parent/guardian and signed by the student-athlete and the parent/guardian.
The Physician's signature is valid for 365 days. If for any reason the Physician's signature expires the parent/guardian should submit a new Physical Form.

Please upload the filled form.
(Only .jpg and .pdf file formats are accepted with maximum file size 10MB)

ATHLETICS CONSENT AND RELEASE FROM LIABILITY CERTIFICATE

Please download and fill THIS FORM in order to proceed.
The Consent and Release from Liability Certificate should be completed by the parent/guardian and signed by the student-athlete and parent-guardian.

Please upload the filled form.
(Only .jpg and .pdf file formats are accepted with maximum file size 10MB)

SUBMISSION OF 3 CERTIFICATES
Please review HERE the instructions for the mandatory webinars that should be watched in order to receive the required Certificates.

Please upload here the Certificate for the Webinar "Concussion for Students"
(Only .jpg and .pdf file formats are accepted with maximum file size 1MB)

Please upload here the Certificate for the Webinar "Sudden Cardiac Arrest"
(Only .jpg and .pdf file formats are accepted with maximum file size 1MB)

Please upload here the Certificate for the Webinar "Heat Illness Prevention"
(Only .jpg and .pdf file formats are accepted with maximum file size 1MB)

EMERGENCY CONTACT - PEOPLE AUTHORIZED TO PICK UP THE STUDENT - ATHLETE

Contact 1 Full Name

Relationship

Tel

Contact 2 Full Name

Relationship

Tel

Contact 3 Full Name

Relationship

Tel

OPT IN AUTHORIZATION FOR EMERGENCY MEDICAL TREATMENT

I hereby give permission to the ACC Staff to take whatever emergency measures are judged necessary for the care and protection of my child(ren) while under ACC supervision. In case of a medical emergency I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment, if the local emergency deems necessary. I understand that in some medical situations the ACC Staff will need to contact the local emergency resources before the parent/guardian. I understand that the incurred expenses will be borne by the child’s family.

INSURANCE POLICY

By selecting this button I agree to hold harmless Archimedean Schools’ Board, the Athletic Department of Archimedean Schools, the Archimedean Middle Conservatory, and the Archimedean Community Center from any direct or implied responsibility for expenses resulting from any before and after school activity injury. The Archimedean Schools’ Board, requires that the parents/guardians of all students participating in the Archimedean extracurricular activities, have medical primary insurance coverage in place for their children on a family plan. The parent/guardian must cover all expenses in the event of an activity-related injury.

PARENT/GUARDIAN PRIMARY INSURANCE THAT INCLUDES THE STUDENT-ATHLETE

Insurance Company Name

Policy Number

COMPETITIVE TEAM PARTICIPATION GENERAL POLICY
In order for the athletic program to maintain competitive athletic teams, parents/guardians of the student-athletes that are selected during try-outs to participate in the AMC athletic teams, are required to contribute to the expenses of the program as they are set by the school’s Administration. The contribution towards the expenses of the athletic team is non-refundable and non-transferable to other teams.

CONTRIBUTION TOWARDS THE EXPENSES OF THE TEAMS
(Please select one or more teams and respond with no for all other options)

AUC Girls Volleyball - Fall Season: 2 monthly payments of $120

Yes No

AUC Boys & Girls Swimming - Fall Season: 2 monthly payments of $120

Yes No

AUC Boys & Girls Cross Country - Fall Season: 2 monthly payments of $80

Yes No

AUC Boys Basketball - Winter Season: 2 monthly payments of $120

Yes No

AUC Boys Soccer - Winter Season: 2 monthly payments of $120

Yes No

AUC Girls Soccer - Winter Season: 2 monthly payments of $120

Yes No

AUC Boys Volleyball - Spring Season: 2 monthly payments of $100

Yes No

AUC Boys & Girls Track & Field: Spring Season: 2 monthly payments of $80

Yes No

OPT IN RECURING PAYMENTS

I opt to make recurring monthly payments via credit card in the amount of this agreement and any extension /addition I may request. Credit card authorisation has been submitted to the Archimedean Cashier at the time of this registration ( a new credit card authorisation form shall be submitted every school year).

PARENT/GUARDIAN CONSENT

I have read, understand, and agree with the insurance and the participation policy that Archimedean Middle Conservatory requires. By signing below I certify that all information I have written on this document are correct and I give my consent for my child to participate in the athletic program of the Archimedean Middle Conservatory and to be transported by buses, when needed, to and from athletic competitions. I give permission to the Archimedean Athletics’ Staff to take whatever emergency measures are deemed necessary for the care and protection of my child while under their supervision. In case of a medical emergency, I understand that my child will be transported to an appropriate medical facility by the local emergency unit for treatment if the local emergency team deems it necessary. It is understood that in some medical situations the Archimedean Athletics’ Staff will need to contact the local emergency resources before the parent/guardian. Finally, I agree to contribute to the expenses of the program as they are set by the school.

Parent/Guardian Signature

Date