Athlete Online Registration Athlete On-line Registration Complete this form to register your son/daughter to participate in a sport at West Bloomfield High School, grades 7 through 12. Step 1 of 4 25% West Bloomfield High School On-line Sports RegistrationAll students who participate in athletics at West Bloomfield High School and their parent(s) must complete this form.This form is intended to be completed simultaneously by both the parent and the student-athlete. This form should be completed for each sports season in which the athlete participates.In addition to this online form, an athletic physical must be completed and turned in to coaches prior to the start of practice.Section I: Student-Athlete information1. Athlete's Name* First Last 2. Sport Participation THIS SEASON*Basketball, BoysBasketball, GirlsCompetitive CheerHockeyPom, WinterSwimming, BoysWrestlingFootballVolleyballTennis, BoysSoccer, BoysCheer, Fall SidelinePom Pon, FallGolf, GirlsSwimming, GirlsCross Country, BoysCross Country, GirlsBaseballSoftballTennis, GirlsGolf, BoysSoccer, GirlsTrack & Field, BoysTrack & Field, GirlsLacrosse, BoysLacrosse, GirlsBowling, BoysBowling, GirlsField HockeyEquestrianFigure SkatingMiddle School SwimSailingSnowboardingGymnasticsSkiing2a. Football Risk Statement: You have been instructed in the proper techniques of blocking, tackling, running, kicking, passing, catching, and other fundamentals pertaining to your position. You have been warned that the improper use of these techniques can result in permanent injury, including paralysis. You have been notified that your helmet is NOCSAE approved within safey standards for football helmets and that you should report to your coach immediately any defects of your helmet or other equipment.* Athlete and Parent have read and agree to the statement of risk for football participation 3. Athlete's Grade*121110090807064. Date of Birth* 5. Athlete's Address* Street Address City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code 6. Athlete's Cell Phone7. Student ID Number8. Parent #1 Name* First Last 9. Parent #1 Cell Phone*10. Parent #1 Email* This email will be sent a confirmation email. 11. Parent #2 Name First Last 12. Parent #2 Cell Phone13. Parent #2 Email Section II: MHSAA Eligibility1. Have you attended another High School other than West Bloomfield High School in the last 12 months?*YesNo1a. If Yes, What was the previous school?2. Are you currently enrolled in any courses offered by a school other than West Bloomfield High School?*YesNo2a. If yes, which school?3. Have you ever accepted money or other valuables from any source for participating in sports?*YesNo4. How many classes did you pass LAST SEMESTER?*76543 or fewer5. Limited Team Membership: The MHSAA prohibits athletes from competing with non-school teams in the same sport during the school season. (e.g. - A Laker hockey player is not allowed to play with a travel hockey team during the high school hockey season.)* Athlete and parent agree to abide by MHSAA limited team membership policy Section III: Health, Safety, and Assumption of Risk1. Consent to Treat: By typing my name (parent) below, permission is hereby given authorizing emergency treatment by the team physician or attending physician in the event of an injury sustained by my son/daughter during athletic participation.*2. Assumption of Risk: Participation in sports requires an acceptance of risk of possible injury, including paralysis or loss of life. As an athlete you can help make athletics safer by not intentionally using techniques that are illegal and which can cause serious injury.* Athlete and parent have read and understand the inherent risks of sport participation 3. Concussion Awareness: Athlete and Parent acknowledge in accordance with Public Acts 342 and 343 of 2012 that I have received and reviewed the Parent's guide to Concussion in Sports provided by the NFHS and West Bloomfield High School that is linked below.* Athlete and Parent Acknowledge receipt and review of Concussion Guide Parent's guide to Concussion in Sports4. You must have health insurance or sign a waiver to participate in sports.*My son/daughter has health insurance.I would like to purchase temporary insurance for my son/daughter.I would like to sign a waiver.4a. Name of Insurance Company*4b. Insurance Policy Number*4c. Complete the attached form below and return with payment to the West Bloomfield High School Athletic Office. MI Premier Student Insurance Plans Brochure 2014-15Notice - Student Insurance BrochuresStudent Insurance - Schedule of Benefits 2014-154d. By typing my name below, I (parent) am accepting risk of any injuries and agree to pay 100% of medical costs associated with injuries my son/daughter sustains while participating in athletics at Novi High School.*5. Consent to Travel: By typing my name below, I (parent) hereby give my son/daughter permission to: be transported by bus, rental van, or personal vehicle to games, tournaments, and competitions when possible; leave from athletic events with a parent, relative, or authorized adult; and accompany the team as a member on its out-of-town trips.*6. Training and Concussion Policy* Parent and student have read the following documents regarding Training Policies and Procedures as well as the Concussion Policy for West Bloomfield High School. Athletic Training Policies and Procedures Concussion Management Policy Section IV: Student Conduct and Sportsmanship1. Student Conduct Policy* Athlete and Parent Agree to abide by Student Conduct Policy Student Conduct Policy 2. Expectation of Sportsmanship: The administration and staff of West Bloomfield High School wish to make it clear that school-sponsored sports are an educational activity. Athletes, parents, and friends must be aware of our school's expectations with regard to sportsmanship. Unlike professional sports, attendance at an educational activity does not entitle one to verbally abuse contestants, coaches, officials, or opponents. As a spectator, we expect that all will display good sportsmanship or refrain from from participating in or attending athletic events.* Athlete and Parent Agree to abide by sportsmanship expectations below 3. Authorization to Release Academic Information: I hereby authorize the release of my child's photograph or confidential academic information (e.g., GPA, ACT/SAT scores, class rank, etc.) for the purpose of being considered for athletic awards and/or recognition by nonschool organizations.* Athlete and Parent Authorization 4. Equipment Financial Responsibility: Each athlete at West Bloomfield High School is responsible of the equipment issued to them. This equipment is to be worn only for practice, coach designated demonstration, or school competitions in the sport for which it was issued. Equipment should be returned to the coach upon completion of the sports season. If the equipment is LOST, STOLEN, DAMAGED, or otherwise not returned, a fine will be issued and report cards held until payment is received or the equipment is returned.* Athlete and Parent Agree to the Equipment Policy Email Please send me updates about West Bloomfield High School and its digital products.
