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RSD Athlete Participation Contract

Student Participation Requirements

Student athletes must have the following completed to participate:

Current Physical on File
Athletic Participation Contract
And review the Athletics and Activities Participation Rules and Discipline Procedures below

Students must have a current physical on file to play. Paper forms are available in the main office or online here:

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Student Information:

Student First Name: *

Student Last Name: *

School of Attendance: *

H.B. Lee Middle School

Reynolds Middle School

Walt Morey Middle School

Student ID#:

Residential Address: (do not use P.O. Box) *

City: *

State: *

Zip Code: *

Birth Date: *

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Age: *

Grade: *

6th Grade

7th Grade

8th Grade

Student Known Allergies (food, drug, insect): [If none, type "None"] *

Special Health Concerns (asthma, medication, etc.): [If none, type "None"] *

If a student is unable to participate for an extended period of time due to injury or illness, a doctor’s release may be required before they will be allowed to resume regular activity. I understand that school officials will use their best judgment in determining emergency care and procedures. I also understand that the school district assumes no financial obligation for expenses incurred in carrying out emergency procedures and/or transportation. *

I understand.

Emergency Contact Information:

Parent/Guardian 1 First Name: *

Parent/Guardian 1 Last Name: *

Parent/Guardian 1 Relationship to Student: *

Parent/Guardian 1 Primary Phone Number: *

Parent/Guardian 1 Alternative Phone Number: *

Parent/Guardian 1 Email: *

Parent/Guardian 2 First Name:

Parent/Guardian 2 Last Name:

Parent/Guardian 2 Primary Phone Number:

Parent/Guardian 2 Alternative Phone Number:

Parent/Guardian 2 Email:

Insurance Information:

The Reynolds School District requires that all students be covered by medical insurance before they will be allowed to participate in athletics and/or activities. The district does not provide medical insurance for student injuries, but does offer affordable student accident/health insurance for voluntary purchase through the Myers-Stevens and Toohey Company (forms are available upon request).

Family Insurance Company: *

Family Insurance Policy Number: *

I agree to maintain adequate insurance coverage and absolve the Reynolds School District of any liability associated with injuries sustained while participating in athletics and/or activities. Furthermore, I agree to provide the athletics office with current emergency and medical information, and hereby give my consent for the above named student to participate fully in all district sponsored programs. By initialing below, I agree to the above statements. *

Parent/Guardian Initials

Clearance Information

Please select all sports of interest: *

Volleyball (Fall Season)

Cross County (Fall Season)

Basketball (Winter Season)

Track & Field (Spring Season)

Physical Examination:

The OSAA and the Reynolds School District require students to have a current physical examination on-file in order to participation in athletics and/or activities. Physical exams must be submitted on the approved OSAA form and they are valid for two years.

Participation Rules and Discipline:

All students and their parent(s) are responsible for the contents of the Reynolds School District Athletics and Activities Participation Rules and Discipline Procedures (distributed with the clearance packet). My signature below indicates that I understand, and agree to follow, the rules and discipline procedures that govern participation in Reynolds School District athletics and activities.

Student Signature

I certify that my signature below indicates that I understand and agree to follow the rules and discipline procedures that govern participation in Reynolds School District athletics and activities. By typing your legal name, you are signing this form electronically. *

Student Signature

Parent/Guardian Signature:

I agree to all of the conditions stated above, I accept the terms outlined in the Athletics and Activities Participation Rules and Discipline Procedures, and I give the above named student permission to participate in Reynolds School District athletics and activities during the current school year. *

Parent/Guardian Signature

Transportation Release:

During the course of the school year, your child may be involved in athletic events and school activities in which the Reynolds School District does not offer transportation. In these instances, parents and students will be responsible for their own transportation. In many activities, the Reynolds School District only offers one-way transportation (no return bus) to the following schools: Centennial, David Douglas, Gresham, and Sam Barlow High Schools. Any time a return trip is not provided, parents are expected to pick their children up after the game. If at any point an update needs to be made to the transportation release, parents/guardians must submit a transportation release addendum form to the Athletic Office (hard copy or electronically). Players who are not approved to drive themselves are required to ride the bus any time transportation is provided – including one-way trips. Two-way trips are always provided in the following sports and activities: cross-country, football, track and field and wrestling; except on weekends or holidays. Any time a two-way trip is provided, all players and coaches are required to ride the bus to and from the event unless prior arrangements are made with the head coach.

I have reviewed the transportation guidelines (available in the Athletics and Activities Participation packet) and I agree to release the Reynolds School District and its employees from all liability associated with the transportation of my child to and from school sponsored events in private vehicles. Furthermore, I accept responsibility for making my child aware of the following restrictions, and enforcing these guidelines. I certify that the above named student has my permission to (check all of the following that apply): *

Ride with others – only valid when a bus is not provided

Ride with parent or guardian.

List full names of who student can ride with when a bus in not provided: *

I agree to all of the conditions stated above, and I give the above named student permission to participate in Reynolds School District athletics and activities during the current school year. By typing your legal name, you are signing this form electronically. *

Parent/Guardian Signature

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