Magnolia Independent School District Uil Athletic Participation Form printable pdf download

MAGNOLIA INDEPENDENT SCHOOL DISTRICT

2017-18

UIL ATHLETIC PARTICIPATION FORM

*Please use Blue/Black ink and Print legibly*

Magnolia ISD Athletics will only accept physicals that are administered and dated no earlier than April 1

of the calendar year that fall sports begin.

School ID #:

Gender:

Male / Female

GRADE :

Student’s Name: __________________________________ Address:____________________________________City/Zip:__________________________

Student’s Cell Phone:_______________ Date of Birth:_________ Age:____ LIST CURRENT MEDICATIONS: ______________________________

DRUG ALLERGIES:________________________________ ALLERGIES

CURRENT MEDICAL CONDITIONS: Asthma: YES

/ Diabetes: YES

/ Seizures: YES

/ Other:

SCHOOL attending in Fall:

Bear Branch Junior High

Magnolia Junior High

Magnolia HS

Magnolia West HS

MALE PARENT: ____________________________________________

FEMALE PARENT: __________________________________________

Home Phone: _________________________________________________

Cell Phone: ___________________________________________________

Work Phone: __________________________________________________

E-Mail Address: _______________________________________________

EMERGENCY CONTACT 1: Please list the emergency contact IN CASE a parent/guardian CANNOT be reached:

Name: ________________________________Home Phone: _______________________ Relationship:

Cell Phone: _____________________________________________________Work Phone: ______________________________________________

HEALTH INSURANCE INFORMATION: Please provide Insurance Information for your student-athlete.

Insurance Company Name: _______________________________ Address:_________________________________________________

Policy and/or Group Identification Numbers: ______________________________________________________

CHECK HERE IF THIS ATHLETE IS COVERED BY EITHER MEDICAID OR CHIP.

CHECK HERE IF THIS ATHLETE IS NOT COVERED UNDER ANY HEALTH INSURANCE PLAN AT THIS TIME

Athletic paperwork and pre-participation forms for Magnolia ISD is online. It is mandatory that all 7th-12th grade prospective student-athletes fill

out UIL and MISD paperwork before they will be allowed to participate in any practice or contest before, during or after school, including tryouts.

The website is designed to stream line the process, and conserve valuable resources.

Go to and complete the Athletic Participation form which includes all mandatory UIL paperwork.

Please have your student’s ID number available when filling out the paperwork. A conformation email will be received when all paperwork

is completed online. Please have a valid email address.

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The Physical & Medical History must still be turned in to an Athletic Trainer at the athlete’s high school or respective coach at middle school. This

informaiton must be dated, signed and stamped by the physician. The physical must also be signed by the parent, and student-athlete.

PARENT OR GUARDIAN’S PERMIT

• I hereby give my consent for the above student to compete in University Interscholastic League approved sports, and travel with the coach or other representative of the school on any trips.

• Furthermore, as a condition of participation and for the purpose of ensuring compliance with University Interscholastic League (UIL) rules, I consent to the disclosure of personally identifiable

information, including information that may be subject to the Family Educational Rights and Privacy Act (FERPA), regarding the above named student between and among the following: the high

school or middle school where the student currently attends or has attended; any school the student transfers to; the relevant District Executive Committee and the UIL. I further understand that all

information relevant to the student’s UIL eligibility and compliance with other UIL rules may be discussed and considered in a public forum. I acknowledge that revocation of this consent must be

in writing and delivered to the student’s school and the UIL.

• It is understood that even though protective equipment is worn by the athlete whenever needed, the possibility of an accident still remains. Neither the University Interscholastic League nor the

high school assumes any responsibility in case an accident occurs.

• I have read and understand the University Interscholastic League rules on the reverse side of this form and agree that my son/daughter will abide by all of the University Interscholastic League

rules.

• The undersigned agrees to be responsible for the safe return of all athletic equipment issued by the school to the above named student.

• If, in the judgment of any representatives of the school, the above student needs immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to

such care and treatment as may be given to said student by any physician, licensed athletic trainer, nurse, hospital, or school representative; and I do hereby agree to indemnify and save harmless

the school and any school representative from any claim by any person whomsoever on account of such care and treatment of said student.

• I have been provided the UIL Parent Information Manual regarding health and safety issues including concussions and my responsibilities as a parent/guardian. I understand that failure to provide

accurate and truthful information on UIL forms could subject the student in question to penalties determined by the UIL.

• The UIL Parent Information Manual is located at

• Your signature below gives authorization that is necessary for the school district, its licensed athletic trainers, coaches, associated physicians and student insurance personnel to share information

concerning medical diagnosis and treatment for your student.

__________________________________

______________________________

_____________

PARENT/GUARDIAN SIGNATURE

STUDENT’S SIGNATURE

DATE