Student - Athlete Data Sheet& Athletic Eligibility Form (Page 2 of 2) in pdf

Athletes Name (Last )______________________________________ (First) ____________________________________

PLEASE PRINT CLEARLY

Sport ____________________________________  Boys

 Girls

School ______________________________

EXTRA CURRICULAR CODE OF CONDUCT & SPORTMANSHIP GUIDELINE

We, the Student and Parent/Guardian, understand that we have the opportunity to attend the preseason meeting conducted by our

Westerville High School Athletic Department, and required by the OHSAA. We have read the Code of Conduct for Students

Participating in Extracurricular Activities (available online at or in the Student Handbook). We understand and

agree to follow all rules listed in this policy. If we violate a policy, we agree to abide by the consequences, which have been

established for the particular violation.

As a representative of Westerville City Schools, my parents and I are aware that our behavior reflects not only the team but also my

coaches, school and community. Questioning the calls of officials, arguing with coaches and teammates, foul language and disrespect

towards opponents are examples of bad conduct and sportsmanship. None of these types of behavior are acceptable. If we display

these behaviors, we are subject to consequences that range from being asked to leave practice/game, and dismissal from the team

and/or removal from all future extracurricular activities. If I am rejected from a contest, I am also subject to punishment from the Ohio

High School Athletic Association and Westerville City Schools. Parents who do not set good examples of good sportsmanship may

be asked to leave and not return to future competitions.

I understand the concepts of acceptable Conduct and Sportsmanship. If I violate the boundaries of appropriate conduct and

sportsmanship, I agree to accept and abide by any consequences delivered by my coach, athletic director, administrator and the Ohio

High School Athletic Association.

WESTERVILLE CITY SCHOOLS PAY-TO-PARTICIPATE FEE

The fee is to be paid within ten (10) days after the Ohio High School Athletic Associations first day of practice for your sport,

deadlines are posted online at > District Athletics. The fee is a participation fee and does not guarantee certain

levels of competition playing time. Nonpayment of participation fee by the deadline will result in denial of participation in the

activity. Refunds may be issued on a case-by-case basis for medical reasons only.

PUBLICITY CONSENT FOR ATHLETIC PURPOSES ONLY

We consent to the publication and use of photographs, video, name or quotes by my student-athlete for use by the Athletic Office.

 Yes

 No

WESTERVILLE CITY SCHOOLS RISK ACKNOWLEDGEMENT STATEMENT

All interscholastic sports activities have within them certain inherent dangers.

The mere nature of the sports activities makes it possible for the participant to sustain injuries; some of which could result in paralysis

or even death.

By signing this form, the participant and their parent/guardians are acknowledging that they understand and accept the risk inherent

within this sport activity.

WESTERVILLE (Central, North or South) HIGH SCHOOL INSURANCE RELEASE

The Student-Athlete named above has insurance covering athletic injuries and it will not be necessary for him/her to purchase

insurance through the school. Westerville Schools can not be liable for insurance coverage.

 Yes

 No

__________________________________________________

STUDENT SIGNATURE

___________________________________________________

DATE: _____/_____/_____

PARENT/GUARDIAN SIGNATURE

REVISED: 8/5/2009

Student - Athlete Data Sheet& Athletic Eligibility Form Page 2

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