Rooster Athletics Participation Form

Rhode Island School for the Deaf

Athletics and After School Programs
Rooster Athletics Participation Form

¿Habla español? ¡Use el menú desplegable en la parte superior derecha!
Dear Parents/Guardians,

We are excited to invite your child to participate in our school’s athletic and after-school sports programs! Athletics play an important role in supporting student growth by promoting teamwork, discipline, physical fitness, and school spirit.

This Sports Participation Form is designed to:
- Confirm your child’s interest in participating in sports and activities for the upcoming school year.
- Provide important medical and emergency information to ensure your child’s safety during practices and games.
- Gather your consent for your child to participate in school-sponsored athletics.
  Please review the form carefully, complete all sections, and attach any required documentation (such as a recent school physical form).
Your timely completion will help us plan teams, schedule practices, and ensure that all students are ready to participate safely.

If you have any questions, please feel free to contact our Athletics Department Director:

Leo Gutierrez
Phone: 401-602-0766
Email: lgutierrez@rideaf.net

We look forward to an exciting season filled with growth, teamwork, and fun! Thank you for supporting your child’s participation in school athletics.

Sincerely,

Rooster Athletics
Student Name*

First NameLast Name
Grade*
Sports Participation (Please check all sports your child is permitted to participate in this year.)*

Youth Boys Soccer (7 to 12 years old)Youth Boys Basketball (7 to 12 years old)Middle School VolleyballMiddle School BasketballMiddle School Track and FieldHigh School SoccerHigh School VolleyballHigh School BasketballHigh School Track and FieldUnified VolleyballUnified Basketball
PHYSICAL CLEARANCE
Physical Clearance*

I confirm that my child has been medically cleared to participate in sports and physical activity.
Please attach the completed School Physical Form for validation purposes. If you already have a up-to-date School Physical Form on file with the school, you may skip this step.

Cancelof
If you do not have a School Physical Form, please download and bring this School Physical Form to a healthcare provider BEFORE continuing. If we do NOT have this, your child will NOT be permitted to play.
AUTHORIZATION TO SELF-CARRY MEDICATIONS/ASTHMA/FOOD ALLERGIES

This section is only for students who may be taking medications, have asthma, or have food allergies. Please read and fill out all information accordingly. Without this information, your student may be exposed to additional risks or removed from play.

MEDICATION USE DURING PRACTICES, HOME GAMES, AND AWAY GAMES: We understand and agree to the following:

1. The parent/guardian and student will meet with a healthcare provider to fill out the following form: Authorization to Self-Administer Medication Form

2. The parent/guardian and student will then meet with the school nurse to review the student’s medication needs.

3. The school nurse will determine if the student can safely self-administer the medication.

4. If approved, the medication will be provided to the nurse in its original, labeled container. The nurse will prepare the medication for secure storage and transport with assigned staff.

5. A designated staff member will store the medication in a secure lockbox and open it only at the appropriate time(s) for the student to take the medication.

6. The student will be responsible for self-administering the medication at the designated time(s).

7. Staff are not responsible for administering the medication, only for making it accessible at the correct time.

ASTHMA: If your child has asthma and requires an inhaler, please fill out this form with your child's healthcare provider and submit it to the dropbox below: Asthma Action Plan

FOOD ALLERGIES: If your child has food allergies and requires an epi-pen, please fill out this form with your child's healthcare provider and submit it to the dropbox below: Food Allergies
File Upload

Cancelof
TRANSPORTATION

Parents/Guardians are responsible for transportation to and from practices and home games.
If you have transportation needs, please check the box.

I have special transportation needs.
EMERGENCY TRANSPORTATION

In case of a medical emergency, whether on school grounds or during an off-site school activity, where an athlete requires a higher level of care than can be provided, transportation to a nearby hospital will be determined. Every effort will be made to contact the parents and the listed emergency contacts prior to or during transport. Refusal to consent may delay delivery of care.
Consent for transportation*

I hereby give consent for transportion of my child to the nearest hospital for treatment in situations where a higher level of care is needed.
Preferred Hospital (If applicable)
ATHLETIC SUPPORT SPECIALIST- PHYSICAL THERAPY

RISD provides a Physical Therapist with specialties in basic life support and first aid. This individual is qualified to provide athletic taping support, strengthening and rehabilitation programs, as well as basic emergency response protocols in the event of athletic injuries.

Rhode Island General Laws (RIGL) Chapter 5-40 — Physical Therapists
Section 5-40-13 – Practice as a Physical Therapist

Please read the following:

Scope of Physical Therapy

- Evaluate movement, strength, balance, posture, and function.
- Develop treatment plans to reduce pain, improve mobility, and restore function.
- Provide exercise programs, hands-on therapy, and education to help you recover or prevent injury.
- Work with athletes, students, and individuals of all ages to improve health and physical performance.
- Refer you to other healthcare professionals if your condition requires care beyond physical therapy.

Limitations of Physical Therapy

- Does not prescribe medications.
- Does not perform surgery or medical procedures.
- Does not provide medical diagnoses of diseases or internal conditions.
- Must refer you to a physician or other provider if your condition requires medical evaluation, testing, or treatment beyond physical therapy.
By law, if you begin physical therapy without a referral, we are required to refer you to a physician or other approved provider within 90 days unless treatment has already concluded.
Consent for Physical Therapy*

I have read and understand the scope and limitations of physical therapy practice in Rhode Island.
INSURANCE INFORMATION
Insurance Provider*
Policy Number*
Group Number (If applicable)*
Emergency Contact Information*

First NameLast Name
Emergency Contact Phone*
Please enter a valid phone number.
POLICY INFORMATION

Student-Athlete/Parent Handbook

Sudden Cardiac Arrest Symptoms and Warning Signs

Concussion Policy

Tree Nuts Policy
Consent to Policies*

I have read and consent to the "Student-Athlete/Parent Handbook."I have read and consent to the "Sudden Cardiac Arrest Symptoms and Warning Signs."I have read and consent to the "Concussion Policy."I have read and consent to the "Tree Nuts Policy."
Consent and Acknowledgment

I, the undersigned parent/guardian, hereby consent to my child participating in athletic programs for the 2025–2026 school year.

I acknowledge that I have provided accurate insurance information above and understand it is my responsibility to ensure this information remains current throughout the season. I also understand that this information may be used to address any medical emergencies arising during athletic participation.

By signing below, I confirm that I have read, understood, and agreed to the terms stated in this consent form.
Parent/Guardian Name*

First NameLast Name
Parent/Guardian Signature*

Clear
Date*

MonthDayYear
Student Name*

First NameLast Name
Student Signature*

Clear
Date*

MonthDayYear
Should be Empty:

Rhode Island School for the Deaf

Rooster Athletics Participation Form