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

Norfolk Public Schools

MIDDLE SCHOOL LEAGUE

ATHLETIC PARTICIPATION/PARENTAL CONSENT/PHYSICAL EXAMINATION FORM

(Separate examination and certification required for each school year – May 1 of the current year through

June 30 of the succeeding year. File in the Office of the Principal)

Part I – ATHLETIC PARTICIPATION/PARENTAL CONSENT

(To be filled in and signed by the parent and the athlete)

Name _____________________________________________ School Year _______________ Grade____________ Sex __________________

Home Address _________________________________________________________________________ City __________________________

Parent’s Home Address __________________________________________________________________ City __________________________

Date of Birth _____________ Place of Birth __________________________________ School Attended Last Year ________________________

I am in the 6

grade

I am in the 7

grade

I am in the 8

grade Name of Middle School:________________________________________

have read the condensed individual Eligibility Rules of the Norfolk Public Schools Middle League that appear below and believe that I am eligible to represent my

middle school in athletics.

Date ________________________________ Student’s Signature ______________________________________________________________

I have read the individual Eligibility Rules listed below and give my consent and approval to the participation in middle school of the student named above. I verify

that the above named student’s medical history has been accurately completed prior to the examination given by a physician. I also give my consent and approval

for the above named student to receive a physical examination, as required in Part III Physician’s Certificate, of this form by ___________________________, M.D.

or by a qualified, registered physician as recommended by the named student’s school administration.

Date ________________________________ Parent’s Signature ______________________________________________________________

INDIVIDUAL ELIGIBILITY RULES

ATTENDTION ATHLETES AND CHEERLEADERS:

TO BE ELIGIBLE TO REPRESENT YOUR SCHOOL IN ANY INTERSCHOLASTIC CONTEST, YOU:

must be a regular bona fide student in good standing of the school you represent

must have been promoted to sixth grade or must have passed five subjects in a school year preceding the present one

must have passed at least five subjects the previous grading period and must be currently taking no less than five subjects

must not have reached your fifteenth birthday on or before the first day of august of the current school year

must have been in residence at your present middle school during the entire semester immediately preceding the one in which you desire to participate

unless you are transferring from a public or private school with a corresponding move on the part of your parents into the area served by your



present school

unless you are transferring to the middle school serving the district in which your parents reside upon completion of the highest grade level offered



by the intermediate school, middle school, or nonpublic school from which you are transferring

unless you are legally adopted, are a foreign exchange student, are under the guidance of an orphanage, the State Department of Welfare, or State



Department of Corrections, or are required to change residence by court order

must not, after entering the seventh grade for the first time or after first enrolling in a school year after passing five subjects, have participated in any

League-sponsored activity more than two years

must be an amateur as defined by the Norfolk Public Schools Middle School League: “An amateur is one who engages in athletics for the educational,

physical, mental, and social benefits one derives therefrom, and to whom athletics are nothing more than an avocation.”

must not have received in recognition of your ability as a middle school athlete any award not presented or approved by your school or the League

must not have participated in any all-star contest between teams whose players are selected from more than one middle school

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

your League and school. If you have any questions regarding your eligibility or are in doubt about the effect of an activity might have on your eligibility, check with

your principal who is aware of the various interpretations and exceptions provided under League rules. Meeting the intent and spirit of League standards will prevent

you, your tam, and community from being penalized.

Athletic Participation/parental Consent/physical Examination Form

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