Athletic Participation/parental Consent/physical Examination Form printable pdf download

HANOVER COUNTY PUBLIC SCHOOLS MIDDLE SCHOOL

Athletic Participation/Parental Consent/Physical Examination Form

May 1

June 30

Separate examination is required for each school year

of the current year through

of the succeeding year.

PART I – ATHLETIC PARTICIPATION

For School

Male _______

(To be filled in and signed by the student)

Year ________

Female _______

Name ___________________________________________________________ Student I.D. #_______________________________

(Last)

(First)

(Middle Initial)

Home Address ______________________________________________________________________________________________

City/Zip Code _______________________________________________________________________________________________

Home Address of Parents ______________________________________________________________________________________

City/Zip Code _______________________________________________________________________________________________

Date of Birth __________________________ Place of Birth __________________________________________________________

This is my _______ semester in ____________________Middle School, and my _______ semester since first entering the sixth grade.

Last semester I attended ______________________________School and passed _______ credit subjects. I have read the condensed

individual eligibility rules of the Hanover/Henrico Middle School Athletic League that appear below and believe I am eligible to

represent my present middle school in athletics.

INDIVIDUAL ELIGIBILITY RULES

To be eligible to represent your school in any Middle School interscholastic athletic contest, you must meet the following guidelines:

•

You must have submitted to your principal or coach before any kind of participation, including tryouts or practice as a member of any

school athletic or cheerleading team, an Athletic Participation/Parental Consent/Physical Examination Form, completely filled in and

properly signed attesting that you have been examined during this school year and found physically fit for athletic competition and that

your parents consent to your participation.

•

You must pass English and Math and any three of the following: science, social studies, physical education/health, and electives.

♦

Fall Sports Participants – must have passed five subjects (English, Math, and 3 others) at the end of the preceding school year.

♦

Winter Sports Participants – must have passed five subjects (English, Math, and 3 others) at the end of the preceding school year

and at the end of the first semester of the current school year if the season extends into the second semester.

♦

Spring Sports Participants – must have passed five subjects (English, Math, and 3 others) at the end of the first semester of the

current school year.

You shall not have reached the age of fifteen (15) on or before August 1 of the school year in which he or she wishes to compete.

A participant in middle school athletics may have six semesters of active participation, providing the age limit requirement is met. A

participant may not represent a team in any sport during more that three seasons.

A member of a team who is absent on the day of a contest may not participate unless written consent is obtained from the principal. A team

member who has been suspended from school may not participate during the period of either in-school or out-of-school suspension.

All eligible middle school students shall play on middle school teams only and will not participate in high school athletics. Exceptions are

for a sport for which there is no middle school team. If there is an unusual case, it shall be brought before the Hanover/Henrico Middle

School Athletic Council review committee.

A student may not practice or compete with more than one middle school interscholastic athletic team at a time.

Eligibility to participate in interscholastic athletics is a privilege you earn by meeting not only the above-listed minimum standards, but also all

other standards set by the Hanover/Henrico Middle School Athletic League, the VHSL, Hanover County, and your school. If you have any

questions regarding your eligibility or are in doubt about the effect an activity might have on your eligibility, check with your principal for

interpretations and exceptions provided under league rules. Meeting the intent and spirit of league standards will prevent you, your team, school

and community from being penalized. Additionally, I give my consent and approval for my picture and name to be printed in any middle

school or VHSL athletic program, publication, or video.

LOCAL SCHOOL DIVISIONS AND THE VHSL MAY REQUIRE ADDITIONAL STANDARDS TO THOSE LISTED ABOVE.

Student Signature: _____________________________________________________ Date: _________________________________

Providing false information will result in ineligibility for one year.

Athletic Participation/parental Consent/physical Examination Form

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