Girls Basketball Clinic

Girls Basketball Clinic

Registration Form

Required

Participant Namerequired
First Name
Last Name
Middle School Clinic Datesrequired
Parent/Guardian Namerequired
First Name
Last Name
 
Athletics Liability Waiver
Statement of Good Healthrequired
List following allergies your son may have
List following medical conditions your son may have
Statement of Risk
I acknowledge that St. Mary’s Ryken High School assumes no responsibility for any risks associated with voluntary participation in school-organized athletics, physical education, or other activities. Furthermore, I understand that these sports activities involve risk of serious injury or death. After weighing these risks against the potential benefits my son/daughter may gain from these activities, I freely and fully accept the risks of athletics on my child’s behalf.
 
Statement of Liability
In exchange for the opportunity to participate in interscholastic athletics, I freely and fully waive any claim by me, my spouse, or my child, against St. Mary’s Ryken High School and its employees arising from a sports-related injury or from transportation to/from a sporting event. Additionally, St. Mary’s Ryken High School’s Certified Athletic Trainers and administrators reserve the right to make final decisions regarding a student/athletes participation status with interscholastic athletic
I acknowledge the statements of Risk and Liability above. required
Parental Consent
  1. Permission is hereby granted to the St. Mary’s Ryken High School Certified/Licensed Athletic Trainers, Faculty, and coaches to proceed with any necessary Primary and Secondary First Aid. In the event of serious illness or injury, I understand that an attempt will be made to contact me in the most expeditious manner possible. If in the event I cannot be reaches, the treatment or referral necessary for the best interest of the above-names student/athlete will be given.
  2. Permission is hereby granted to the St. Mary’s Ryken High School Certified/Licensed Athletic Trainer to proceed with any necessary evaluation, minor medical treatment, and/or rehabilitation of injuries for the above-named student/athlete.
  3. Permission is hereby granted to the St. Mary’s Ryken High School Certified/Licensed Athletic Trainer to proceed with any necessary use of modalities (including but not limited to: Moist Heat, Ultrasound, Electric Stimulation, T.E.N.S., Compression Unit, Whirlpools) for the care, treatment, and rehabilitation for the above-named student/athlete’s injury(s). All modalities will be used under the direction of the St. Mary’s Ryken High School Team Physician and/or other referring physicians and will only be administered by the St. Mary’s Ryken High School Certified/Licensed Athletic Trainers.
Parental Consent to Treatrequired
 
Emergency Contact Information
Emergency Contact namerequired
First Name
Last Name