Registration And Participation Consent Form

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Registration and Participation Consent Form
Please complete all sections of this form for the athlete named below. Please complete one form for each
athlete in your family. In addition to this form a WIAA Physical Form or Alternate Year card is required as well
as an ImPACT test consent form. Athletes will not be allowed to participate in practice or contests until all
required paperwork is on file in the WLA office.
Student Name
Grade
2016-2017
Athletic Handbook
, including, but not limited to the Athletic Code of Contact
I have received a copy of, read, and understand the Winnebago Lutheran Academy Athletic Code of Conduct. I
agree to abide by the Code of Conduct as a WLA athlete. I also understand that the WLA code of conduct is in
effect twelve months of the year. As parent/guardian I give permission to my child to participate in athletics
offered by Winnebago Lutheran Academy. Winnebago Lutheran Academy, its staff, coaches, volunteers and
agents cannot be held liable for any injury/illness suffered as a result of these activities. As parent/guardian I
assume the liability and responsibility for any and all risk associated, both physical and financial.
Student Signature
Date
Parent Signature
Date
Wisconsin Interscholastic Athletic Association (WIAA) Eligibility Form
I have received a copy of, read, and understand the WIAA Eligibility Information Bulletin. I agree to abide by all
WIAA rules and regulations as they apply to athletic participation while I am a student at WLA. I also
understand that the WIAA rules are in effect twelve months of the year.
Student Signature
Date
Parent Signature
Date
Parent Athlete Participation and Treatment Consent
Parental or guardian consent must be granted annually for student-athlete participation. As parent or
guardian, with your signature consent to allow the student named below to engage in interscholastic athletics
sponsored by WLA during the current school year. Furthermore, permission is granted this athlete to
accompany teams he or she is a member of on out-of-town trips. It is understood that this child will also be
expected to firmly adhere to all established school and athletic policies. I hereby grant permission to
Winnebago Lutheran Academy and its representatives to seek medical attention for illness and/or injury
incurred during practice or competition. I have provided detailed and up-to-date medical information via this
student’s Power School profile.
Student Signature
Date
Parent Signature
Date

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