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Madison College Athletics Release Forms

Madison College Athletics Release Forms

Must be filled out prior to practicing or competing
21Questions

HIPAA

Compliance

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    • Baseball
    • Basketball (Men's)
    • Basketball (Women's)
    • Esports
    • Golf (Men's)
    • Golf (Women's)
    • Soccer (Men's)
    • Soccer (Women's)
    • Softball
    • Volleyball (Women's)
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    Student-Athlete Information & Publicity Release

    I hereby authorize the Madison College Athletic Department as follows:

    1. to announce or publicize my membership on any Madison College athletic team and my continuing eligibility for such teams, including the reason for any lack of continuing eligibility;

    2. to announce or publicize any departmental or coaching staff decision that affects my continuing participation on any Madison College athletic team;

    3. to announce or publicize my selection for membership on honor teams or lists formed based on academics and/or athletics;

    4. to access and release to an organizing or sponsorship body, my GPA and/or major, to nominate or recommend me for an academic and/or athletic award or other positive recognition;

    5. to use my name, photograph, likeness, and image for publicity and promotional uses so long as such complies with NJCAA rules;

    6. to access and use my “directory information” for usual and customary Intercollegiate Athletics purposes, if I have opted out of the College’s “directory information” release;

    7. to have access to College information related to any allegation of misconduct, whether academic or otherwise, to determine any impact on my continuing eligibility and/or participation;

    8. to disclose non-medical personally identifiable information to correct inaccurate statements reported by the media;

    9. to announce or publicize my medical availability to participate in intercollegiate athletic competition, to include only the following health information: the fact that I am sick or injured and unable to compete; if I am injured, the name of the body part injured; and a statement of the estimated time for me to recover and return to athletic competition.

    10. to the release of any and all information about education records to verify and certify student-athlete eligibility per athletic association rules and regulations, and for the release of information to verify attendance at and participation in student activities and/or intercollegiate athletics at Madison College.

    This authorization will be in effect for one calendar year from the date signed. I also understand and agree that this form is a requirement for my participation in intercollegiate athletics at Madison College.

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    Please read the Student-Athlete Information & Publicity Release. 

    Agreement to the release is a requirement for your participation in intercollegiate athletics at Madison College.

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    Student-Athlete Code of Conduct Policy

    Participating in Madison College's long-standing, proud tradition of intercollegiate athletics is an honor. As a student-athlete, Madison College expects me to experience personal growth, academic achievement, and athletic success. I appreciate the membership and realize that participation in intercollegiate athletics at Madison College is a privilege, not a right.

    We expect all Madison College student-athletes to be positive, respectful, honest, and accountable leaders and role models. Student-athlete conduct reflects on the individual and their teammates, coaches, the department, and the college. Therefore, Madison College Athletics expects student-athletes to behave as respectful members of an intercollegiate team and in a manner that is consistent with Madison College's values at all times.

    I agree to conduct myself in accordance with all rules and requirements of the National Junior College Athletic Association (NJCAA), NJCAA Region 4, Madison College, and the rules of my team. I also agree as follows:

    1. College Community: I will be a responsible and engaged member of the college community. I will strive to represent my team in and outside the classroom and show respect for all members of the college and the broader community. I will lead by example. I will remember that my and my team’s reputations are at stake when I participate in intercollegiate competitions, attend classes, and socialize with friends and others, both on and off campus, at Madison College.

    2. Academic Standing: I will assume full responsibility for my academic progress and achievement and make every effort to stay in good academic standing. I will attend all my classes and seek additional academic help to improve or maintain my academic standing.

    3. Travel as a College Ambassador: When traveling for competitions as a representative of Madison College and my team, I will always conduct myself responsibly and maintain a positive image of Madison College.

    4. Online: I will not author, forward, or post vulgar or offensive notes, texts, photographs, or other content that reflect negatively on me, my team, other individuals, or the college or that conflict with the spirit or intent of this code.

    5. Alcohol and Drug Use: I will not consume alcoholic beverages on team trips or at athletic events. I will not use or distribute banned substances.

    6. Violence: I will not engage in and will not be tolerant of violent acts, including assaults on persons or property, hate crimes, hazing, stalking, sexual violence, or any other conduct prohibited by law or college policy. If I witness such acts perpetrated by others, I will report them to my coach or another college authority immediately.

    7. Non-consensual Sexual Contact: I will not initiate or engage in non-consensual sexual contact or sexual harassment, and I acknowledge that all forms of harassment and non-consensual sexual contact are prohibited both by law and Madison College rules.

    8. Hazing: Hazing in connection with membership or participation in college athletic team activities is strictly prohibited. Hazing includes but is not limited to any conduct or method of initiation, admission, or condition of continued membership in any student organization which: 1) endangers the physical or mental health or safety of any student or other person, including extending deprivation of sleep or rest; forced consumption of food, liquor, beverage, or drugs; beating or branding; involuntary confinement or imprisonment; or 2) destroys, vandalizes, or removes public or private property.

    9. Remaining Informed of Expectations and Policies: I am responsible for my behavior and for reading, understanding, and abiding by the policies applicable to me, including but not limited to the Code of Conduct and the Madison College Student Code of Conduct.

    I fully understand that failure to conduct myself responsibly, as stated and implied by the conditions in this Madison College Student-Athlete Code of Conduct and through my coach’s team rules, may result in any of the following measures:

    • Reprimand by the Athletic Department
    • Imposition of reasonable terms & conditions on continued status as a team member
    • Counseling and/or participation in a program of training
    • Apology and/or Community service
    • Continued suspension
    • Dismissal from the team
    • Reinstatement
    • Other measures suggested by the student-athlete’s coach

    The head coach of that sport will determine disciplinary action. The Director of Athletics and the Vice President of Student Affairs reserve the right to review and amend any action.

    Student-Athlete Appeal Process

    The student-athlete reserves the right to file a written appeal to the Director of Athletics within one week of the disciplinary action. The appeal will be reviewed by a group consisting of the Director of Athletics, an Athletics full-time staff member, a designated faculty representative, and two team captains of other sports. The appeal review and final decision will be made within fourteen days of receiving the appeal request.

    Report Requirement

    Student-athletes must immediately report any behavior that may violate the Student-Athlete Code of Conduct and/or any criminal charges brought against them to the head coach of their sport and/or the Director of Athletics. If a student-athlete fails to report as required and is found to have violated the Student-Athlete Code of Conduct, they may be permanently dismissed from the team.

    Madison College’s Policy

    Madison College has a formal Student Code of Conduct Policy in the student handbook and other publications. Violations of the Student-Athlete Code of Conduct may also result in violations of the general Student Code of Conduct Policy, which will be dealt with independently.

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    Please read the Student-Athlete Code of Conduct Policy. 

    Agreement to the policy is a requirement for your participation in intercollegiate athletics at Madison College.

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    Acceptance of Risks & Release of Liability

    The undersigned hereby acknowledges that he/she understands that trying out for and/or participation in any sports activities of Madison College is purely voluntary. The undersigned agrees to release Madison College, its successors, assigns, officers, agents, and employees from any and all claims, demands, and causes of action whatsoever in any way growing out of or resulting from the undersigned student’s participation in the activities of any such sport activity, including try-outs.

    To participate in athletics, you must certify that you are physically able to do so. If you have a physical limitation that prevents your participation in any intercollegiate sport and/or related sporting activity, you must supply a doctor’s statement. Agreement with this statement certifies that you are fit to participate.

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    Please read the Acceptance of Risks & Release of Liability. 

    Agreement to this is a requirement for your participation in intercollegiate athletics at Madison College.

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    Health Insurance Information Release

    Many of the activities of sports involve substantial risk of injury, and Madison College District provides an “excess basis” medical insurance coverage (maximum of $25,000 for accidental injuries) for such injuries sustained while participating in officially sanctioned intercollegiate sporting activities at Madison College. The benefits of said policy are secondary and supplementary to coverage you have through a group, an employer, or as a dependent under your parents’ or guardians’ insurance.

    We encouraged you to secure adequate health insurance protection. You understand and agree that you are required to notify and consult with the designated, on-site Madison College licensed athletic trainer before receiving any medical care and/or treatment desired as a result of an accident or injury sustained in an officially sanctioned Madison College intercollegiate sporting activity.

    You agree to submit any outstanding bills to the athletic department office within 30 days of receipt. If you choose to receive treatment and/or care without said prior notification and consultation, you understand that all financial obligations will be your sole responsibility.

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  • 16

    Please read the Health Insurance Information Release. 

    Agreement to the release is a requirement for your participation in intercollegiate athletics at Madison College.

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  • 17

    Implicit Eligibility & Student-Athlete Obligation Understanding & Release

    1. I understand and agree that I cannot drop or add a class(es) after the first 18 days of the semester without system release from the Athletic Academic Advisor and the Director of Athletics.

    2. I agree to allow Madison College faculty to complete all requested information regarding my class attendance and academic performance using the Madison College Student-Athlete Academic Performance Reporting Form.

    3. I understand that it is my obligation to attend the end-of-season meeting for my sport and complete the season-ending sports evaluation. I understand that I will be put on an athletic hold if I do not complete the online evaluation.

    4. I agree to be present at the annual Wolfie's end-of-the-season celebration.

    5. I agree to attend the required student development sessions each semester.

    6. I agree to be present at the annual All-Teams Fall Festival.
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  • 19

    Please read the Implicit Eligibility & Student-Athlete Obligation Understanding & Release. 

    Agreement to the release is a requirement for your participation in intercollegiate athletics at Madison College.

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