Quimby Oak After School Sports Registration

Dear Parents/Guardians,

For any student to participate in the Quimby Oak Middle School After School Sports Program, the information requested below is essential. Since the possibility of injury is present in even the mildest of athletic events, some form of accident or health insurance is required before any student will be allowed to participate in any sport. There is a space provided below for you to indicate the type of insurance you carry. There is also insurance coverage available by an outside carrier made available through the school district. Your son or daughter may not participate in our After School Sports Program without insurance coverage.

Student Eligibility

Student eligibility will be determined at the regular reporting periods using either quarterly report cards or progress reports. A GPA of 2.0 and no “F” grade is the minimum requirement to participate on the team. At the beginning of each sport, all student-athletes are considered on “probation” until the regular quarterly report card or progress report, which comes out during their respective season, is issued. The date this official report is distributed at school is the “cut date.” Students who do not meet the minimum requirement:

Are not eligible to participate in practices or events.
Will be dropped from the team roster.

A student who becomes ineligible for one sport may try out for a future sport. The same eligibility requirements will apply.

If you have questions about the Quimby After School Sports program, please contact our Athletic Directors: Ms. Colleen Boyle and Mr. Jonathan Lam.

Student First Name *

Student Last Name *

Student ID#*

Student Grade*

7th Grade8th Grade

Student Email (Please no eesd.org email)*

Confirmation Email

Student Mobile Number*

Sport Registering For: *

Parent #1 Name*

First NameLast Name

Parent#1 Mobile Number*

Parent #1 Email*

Confirmation Email

Add 2nd parent info?

YesNo

Parent #2 Name*

First NameLast Name

Parent#2 Mobile Number

Parent #2 Email*

Confirmation Email

Medical Condition - Please briefly describe your child's medical condition. If they do not have a condition, please state None. *

My child is covered by health insurance*

YesNo

Family insurance carrier name: *

Impact of clicking No Health Insurance Coverage*

Subscriber's name on insurance card *

Insurance Card Group Number *

Please provide two emergency contacts in case we are unable to contact

Parent #1 or Parent #2:

Emergency Contact #1*

First NameLast Name

Emergency #1 Phone #*

Emergency Contact #2*

First NameLast Name

Emergency #2 Phone #*

In case of an emergency and the parents or emergency contacts cannot be reached, I authorize school personnel to take any action deemed necessary.*

YesNo

Clicking "No" to school personnel authorization for emergencies*

Game schedules are available on the school website (quimbyoak.eesd.org) under Athletics on the blue menu bar. Select the sport your child is participating in to view, print or automatically add the schedule to your personal calendar.

Throughout the season there may be changes in practice times and game scheudules. The best way for us to text or email you is through the information you have listed in your Powerschool account. Please make sure all your contact information is correct in Powerschool so you can receive last minute notifications.

I have verified my Powerschool account has my current mobile phone and email information.*

YesNo

Please use my mobile and email to alert me of any changes to the sports schedule or event details.*

YesNo

By selecting "No" to the use of your mobile or email to alert you of any sports events details:*

Publicity and Social Media

I give Quimby Oak and Evergreen School District permission to use photos and videos of my child for communication and publicity purposes on their school website, social media accounts and newsletter.*

YesNo

By not allowing your student's picture to be viewed in a public forum for school:*

Parents attending Athletic Events: To protect the privacy rights of our students, at no time should pictures or video of children, except your own, be posted to any website or social media without permission from the child’s parent or legal guardian.*

I have read, understand and will adhere to the school's social media policy.

Document Name	Read
Quimby Oak Sports Contract	Read Document
Concussion Info Sheet	Read Document
Sudden Cardiac Arrest Info Sheet	Read Document

(Check here to indicate that you have read and agree to the terms of the Quimby Oak Sports Contract) *

(Check here to indicate that you have read and agree to the terms of the Concussion Info Sheet)*

(Check here to indicate that you have read and agree to the terms of the Sudden Cardiac Arrest Info Sheet) *

Guardian E-Signature*

Type your full name to e-sign. NOTE: E-signature must match a guardian's name*

Student E-Signature*

Type your full name to e-sign. NOTE: E-signature must match athlete's legal name*

Student Athlete Information

Parent Contact Information

Medical and Insurance Information

Emergency Information

Communication

Agreement and Signed Consent