* Indicates Response Required

Athletics Registration Form

Hingham High School Athletics
(781) 741-1560 x5

Student-Athlete Information

First Name *

Last Name *

Birth Date

Age as of September 1st *

Grade

Sex *

Email Address *

What Fall Sport Would You Like To Signup For?

What Winter Sport Would You Like To Signup For?

What Spring Sport Would You Like To Signup For?

Cell Phone *

Did your child attend another school last year, other than Hingham High School or Hingham Middle School? If yes, please list the school(s) below and see email Ms. Conaty immediately to explain the details. *

Has your child repeated a grade in high school? *

Will Your child Be 19 before September 1st this year? *

Parent/Guardian Information

Mother or Primary Guardian First Name (if none, please type none)

Mother or Primary Guardian Last Name (if none, please type none)

Mother's Email Address *

Father or Other Guardian First Name (if none just type none)

Father or Other Guardian Last Name (if none, just type none)

Home Address *

Father's Email Address *

City *

Zip *

Home Phone

Mother/Primary Guardian Cell Phone

Father/Guardian Cell Phone

Eligibility Requirements / Acknowledgement

1. Academic Eligibility - In order for a student to tryout, practice or participate in any capacity, he/she must be academically eligible. A student becomes academically ineligible if during the last marking period preceding the athletic contest, the student has two (2) F's (failure), two (2) I's (incomplete), two (2) N's (no credit), two (2) WF's or any combination thereof recorded on their report card. Eligibility is determined by the date on which report cards are issued. *

I Understand and Accept This Rule

2. A student who turns 19 before September 1st becomes ineligible to participate in interscholastic athletics. In some cases a waiver can be pursued through the MIAA. If you participate without the waiver, your team will forfeit all games in which you participate. *

I Understand and Accept This Rule

3. All student-athletes must have an up to date physical on file before being allowed to tryout or participate in any sport. A physical is valid for 13 months from the date it was conducted. A student becomes ineligible to participate when the physical expires. It is the responsibility of the student and parent to be sure they have an up to date physical. It is quite possible that there will be no reminder that your physical is set to expire. *

I Understand and Accept This Rule

4. Student-athletes must pay a $325.00 per year user fee to participate in all sports except Crew and Dance. Ice Hockey is an additional $100.00. The Crew and Dance programs charge a seperate fee that is paid directly to their parent booster organization. The separate rower fee is $610/rowing season and each additional sibling will pay $385.00. The Dance Team user fee will be established at the 8/26 meeting. *

I Understand and Accept This Rule

5. The MIAA Bona Fide Team Member Rule #45 is in effect here at Hingham High School. This rule states that no high school athlete may skip a practice or game in order to participate in an athletic event with a non-school team. A coach does not have the authority to grant permission for a student to miss a high school event for a non-school athletic event. In certain cases there is a waiver process which can be filed if the coach, athletic director and principal deem the waiver request to be appropriate. *

I Understand and Accept This Rule

6. Chemical Health/Alcohol/Drugs/Tobacco Rule - This rule states: “From the earliest fall practice date (the first day football practices), to the conclusion of the academic year or the final athletic event (whichever is later), a student shall not use, consume, possess (possession includes group possession, e.g.,in automobiles, etc.), buy/sell or give away any of the following: a) A beverage(s) containing alcohol; b) any tobacco product c) marijuana d) illegal steroids e) or any other controlled substance The penalties for violation of this rule are spelled out in the MIAA and HHS Student Handbook. In addition, students who are in violation of this rule may not serve as a captain in any sport for one full year and they may not be named as an all-star for any sport in which they served a chemical health violation suspension. *

I Understand and Accept This Rule

7. I agree to notify the athletic director, school nurse, guidance counselor and athletic trainer in writing (letter or email) if my child has any changes in their medical conditions, especially head injuries during the school year. This includes notifying the school if my child has any type of head injury away from school. *

I Understand and Accept This Rule

Date *

Permission Slip

I give my permission for my son/daughter to participate in the Hingham High School athletic program. Hingham Public Schools and it's trainers and coaches have my permission to seek necessary emergency treatment for my son/daughter during his/her particiaption in athletics, practices, games and conditioning workouts. I understand it is my responsibility to provide an EPI-PEN and/or inhaler and written doctor's orders, if needed for my child. I agree to give my permission for my son/daughter to be transported by school transportation. This permission remains in effect for this academic year only. I also understand that Massachusetts General Laws require all parents of students participating in high school athletics to become educated on the serious issues of head injuries and concussions. I have met the education requirement by either attending the pre-season athletic presentation or by completing the online course. By signing this, I am affirming that I have indeed complied with this obligation and that I have no questions with regard to the concussion policy or any issues relation to concussions. *

I fully understand and accept all of the provisions outlined above

Date *

Electronic Signatures Are Binding. By typing my name, I am signing that I agree with all of these provisions. *

Pre-Participation Medical History Form

1. Concussion Information - Hingham High School offers the ImPACT Baseline Concussion Screening to all student-athletes. In addition to ImPACT, the Commonwealth of Massachusetts requires that all athletes and parents or guardians take an online concussion course each year. These are the links for the courses: http://www.cdc.gov/concussion/HeadsUp/online_training.html http://www.nfhslearn.com I acknowledge that I have taken the online concussion screening course. (Please sign in open blank) *

2. Has your child ever experienced a traumatic head injury? *

3. Has your son or daughter ever been diagnosed with a concussion? If yes, please list the date of each instance *

4. Does your child require an EPI-PEN or inhaler? If yes, written doctor's orders and EPI-PEN/inhaler must be provided before he/she may participate in athletics. *

Date *

Hingham High School Athletics - Emergency Contact Card

Student Name *

Date of Birth *

Allergies *

Emergency Contact #1 Name *

Emergency Contact #1 Phone *

Emergency Contact #2 Name *

Emergency Contact #2 Phone *

Emergency Contact #3 Name *

Emergency Contact #3 Phone *

Primary Care Physician - Name and Phone Number *

Health Insurance Company *

Policy Number *

PERMISSION TO TREAT - I give my permission for the team physician, school nurse, athletic trainer, E.M.T., paramedic, coach or other first-responder to render first aid or other appropriate medical treatment deemed necessary by the person or persons providing the care. This permission extends to all hospital personnel. However, I do not hold any of the above responsible for the medical care or lack there-of. Although I expect every attempt to contact me (emergency contact #1), I understand that this is not required. By typing my name in this box, I agree that this electronic signature affirms my approval. *

Date *

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