AUC Athletics Registration Form - Archimedean Schools

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)

PRE-PARTICIPATION PHYSICAL EVALUATION FORM

Please download THIS FORM and after completing the necessary fields please upload ONLY the pages 4 and 5.
The Pre-participation Physical Evaluation Form has 5 pages.
Pages 1 and 2 should be completed and signed by the student-athlete and the parent(s). These 2 pages should be retained by the healthcare provider and/or parent.
Page 3 should be completed, signed, and retained by the Health Care Professional.
Page 4 should be completed and signed by the student-athlete, the parent(s), and the Health Care Professional. This page should be submitted to the school (please upload).
Page 5 is only used or requested if a student-athlete has been referred for additional evaluation prior to full medical clearance. This page should be submitted to the school when used (please upload).

Please upload the 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 out 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 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.
* The Certificates should be under the name of the student-athlete.

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

INSURANCE POLICY

By selecting this button I agree to hold harmless Archimedean Schools’ Board, the Athletic Department of Archimedean Schools, 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 Archimedean 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 $125

Yes No

AUC Boys & Girls Swimming - Fall Season: 2 monthly payments of $125

Yes No

AUC Boys & Girls Cross Country - Fall Season: 2 monthly payments of $85

Yes No

AUC Boys Basketball - Winter Season: 2 monthly payments of $125

Yes No

AUC Boys Soccer - Winter Season: 2 monthly payments of $125

Yes No

AUC Girls Soccer - Winter Season: 2 monthly payments of $125

Yes No

AUC Boys Volleyball - Spring Season: 2 monthly payments of $105

Yes No

AUC Boys & Girls Track & Field: Spring Season: 2 monthly payments of $85

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 authorization has been submitted to the Archimedean Cashier at the time of this registration ( a new credit card authorization form shall be submitted every school year).
Please download the CRETID CARD AUTHORIZATION FORM and after completing the necessary fields please email the form to [email protected]

PARENT/GUARDIAN CONSENT

I have read, understand, and agree with the insurance and the participation policy that Archimedean Schools require. 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 Archimedean Athletic Program 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