Athletic Forms

STUDENT ATHLETE INFORMATION

How many students do you have interested in participating in Winter Sports? REQUIRED Please fill out this field.
Student Athlete Information 1
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Student Gender REQUIRED Please fill out this field.
- Student Grade REQUIRED Please fill out this field.
- In which Spring Sport is this student interested? REQUIRED Basketball Cheerleading Please fill out this field.
- Physical Evaluation
  
  It is preferred and encouraged that ALL Student Athletes have a current Physical on file with the school. You can find the IHSAA Phyiscal Form here for your medical provider to complete. If have not submitted a physical form for the 2023-2024 school year, or if you chose to not provide a current physical form, you must complete a waiver of physical evaluation.
- Waiver of Physical Evaluation
  
  As the parent/legal guardian of this student, a student athlete with Sts. Joan of Arc & Patrick School, I elect to not have my child undergo a physical examination prior to participating in school athletics. I believe my child to be in good physical condition and able to participate in school athletic activities, including practices and competition. I understand and accept the risks associated with participation in school athletic activities. I hereby waive any liability on the part of the school and agree to hold the school free of all claims resulting from injury or health emergencies associated in any way with school athletic activities.
- This Student Athlete: REQUIRED Please fill out this field.
- Parent/Guardian Initials (Physical Evaulation) REQUIRED Please fill out this field. Please enter valid data.
Student Athlete Information 2
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Student Gender REQUIRED Please fill out this field.
- Student Grade REQUIRED Please fill out this field.
- In which Spring Sport is this student interested? REQUIRED Basketball Cheerleading Please fill out this field.
- Physical Evaluation
  
  It is preferred and encouraged that ALL Student Athletes have a current Physical on file with the school. You can find the IHSAA Phyiscal Form here for your medical provider to complete. If have not submitted a physical form for the 2023-2024 school year, or if you chose to not provide a current physical form, you must complete a waiver of physical evaluation.
- Waiver of Physical Evaluation
  
  As the parent/legal guardian of this student, a student athlete with Sts. Joan of Arc & Patrick School, I elect to not have my child undergo a physical examination prior to participating in school athletics. I believe my child to be in good physical condition and able to participate in school athletic activities, including practices and competition. I understand and accept the risks associated with participation in school athletic activities. I hereby waive any liability on the part of the school and agree to hold the school free of all claims resulting from injury or health emergencies associated in any way with school athletic activities.
- This Student Athlete: REQUIRED Please fill out this field.
- Parent/Guardian Initials (Physical Evaulation) REQUIRED Please fill out this field. Please enter valid data.
Student Athlete Information 3
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Student Gender REQUIRED Please fill out this field.
- Student Grade REQUIRED Please fill out this field.
- In which Spring Sport is this student interested? REQUIRED Basketball Cheerleading Please fill out this field.
- Physical Evaluation
  
  It is preferred and encouraged that ALL Student Athletes have a current Physical on file with the school. You can find the IHSAA Phyiscal Form here for your medical provider to complete. If have not submitted a physical form for the 2023-2024 school year, or if you chose to not provide a current physical form, you must complete a waiver of physical evaluation.
- Waiver of Physical Evaluation
  
  As the parent/legal guardian of this student, a student athlete with Sts. Joan of Arc & Patrick School, I elect to not have my child undergo a physical examination prior to participating in school athletics. I believe my child to be in good physical condition and able to participate in school athletic activities, including practices and competition. I understand and accept the risks associated with participation in school athletic activities. I hereby waive any liability on the part of the school and agree to hold the school free of all claims resulting from injury or health emergencies associated in any way with school athletic activities.
- This Student Athlete: REQUIRED Please fill out this field.
- Parent/Guardian Initials (Physical Evaulation) REQUIRED Please fill out this field. Please enter valid data.
Student Athlete Information 4
- First Name REQUIRED Please fill out this field. Please enter valid data.
  
  Last Name REQUIRED Please fill out this field. Please enter valid data.
- Student Gender REQUIRED Please fill out this field.
- Student Grade REQUIRED Please fill out this field.
- In which Spring Sport is this student interested? REQUIRED Basketball Cheerleading Please fill out this field.
- Physical Evaluation
  
  It is preferred and encouraged that ALL Student Athletes have a current Physical on file with the school. You can find the IHSAA Phyiscal Form here for your medical provider to complete. If have not submitted a physical form for the 2023-2024 school year, or if you chose to not provide a current physical form, you must complete a waiver of physical evaluation.
- Waiver of Physical Evaluation
  
  As the parent/legal guardian of this student, a student athlete with Sts. Joan of Arc & Patrick School, I elect to not have my child undergo a physical examination prior to participating in school athletics. I believe my child to be in good physical condition and able to participate in school athletic activities, including practices and competition. I understand and accept the risks associated with participation in school athletic activities. I hereby waive any liability on the part of the school and agree to hold the school free of all claims resulting from injury or health emergencies associated in any way with school athletic activities.
- This Student Athlete: REQUIRED Please fill out this field.
- Parent/Guardian Initials (Physical Evaulation) REQUIRED Please fill out this field. Please enter valid data.

LIABILITY, RELEASE & CONSENT
In consideration of my participation in Sts. Joan of Arc & Patrick School Athletic Programs, I agree to be bound by each of the following: 1. Eligibility: I agree to comply with the rules of participation as defined in the Sts. Joan of Arc & Patrick School (STSJP) Handbook. 2. Readiness to Participate: I will only participate in those STSJP athletic activities for which I believe I am physically and psychologically prepared. I agree that I will follow all reasonable directions and commands of my coaching staff. 3. Medical Attention: I hereby give my consent to STSJP to arrange transportation to a medical facility or onsite emergency medical services as warranted in the course of my child(ren)'s participation. 4. Waiver and Release: I am fully aware of and appreciate the risk of injury including the risk of catastrophic injury, paralysis, even death as well as other damages and losses associated with participation in athletic activities. I further agree that STSJP and its employees, agents, officers, volunteers and/or directors shall not be liable for any losses or damages occurring as a result of my child(ren)'s participation in the athletic program, except where such loss or damage is the result of intentional harm or reckless conduct of one of the organization or individuals identified above. As a legal parent or guardian of this/these athlete(s), I hereby verify, by placing my initials below, that I fully understand and accept each of the above conditions for permitting my child(ren) to participate in the STSJP sport(s) for which I have registered. In the event that I cannot be reached, I hereby give my consent to the attending physicians, trainers, staff and coaches to secure and/or administer emergency medical aid and obtain ambulance service if needed. It will be necessary for the parents/guardians of student-athlete(s) to provide transportation for their child(ren) to/from athletic events or off-site practices. By placing my initials below, I state that I have read and understand that I accept the above statements, and I accept full responsibility for the transportation of my student-athlete(s) to/from athletic events.

Parent/Guardian Initials (Medical) REQUIRED Please fill out this field. Please enter valid data.

Parent/Guardian Initials (Transportation) REQUIRED Please fill out this field. Please enter valid data.

CONCUSSION & CARDIAC ARREST PROTOCOL
IC 20-34-7 and IC 20-34-8 require schools to distribute information sheets to inform and educate student athletes and their parents on the nature and risk of concussion, head injury and sudden cardiac arrest to student athletes, including the risks of continuing to play after concussion or head injury. These laws require that each year, before beginning practice for an interscholastic sport, a student athlete and the student athlete’s parents must be given an information sheet, and both must sign and return a form acknowledging receipt of the information to the student athlete’s coach. IC 20-34-7 states that an interscholastic student athlete, in grades 5-12, who is suspected of sustaining a concussion or head injury in a practice or game, shall be removed from play at the time of injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider trained in the evaluation and management of concussions and head injuries, and at least twenty-four hours have passed since the injury occurred. IC 20-34-8 states that a student athlete who is suspected of experiencing symptoms of sudden cardiac arrest shall be removed from play and may not return to play until the coach has received verbal permission from a parent or legal guardian for the student athlete to return to play. Within twenty-four hours, this verbal permission must be replaced by a written statement from the parent or guardian. Parent/Guardian - please read the fact sheets available here regarding concussion and sudden cardiac arrest and ensure that your student athlete(s) has also received and read these fact sheets. As a parent or guardian of a student athlete(s) at Sts. Joan of Arc & Patrick School, I acknowledge that our family has received and read the fact sheets regarding concussion and sudden cardiac arrest. I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury, and the symptoms of sudden cardiac arrest.

Parent/Guardian Initials (Concussion/Cardiac Arrest) REQUIRED Please fill out this field. Please enter valid data.

Medical Data Pertinent to Your Child (conditions/allergies/ or any other concerns you would like to make us aware of): REQUIRED Please fill out this field.

Medical Insurance Provider REQUIRED Please fill out this field. Please enter valid data.

Medical Insurance Policy # REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Info

First Name REQUIRED Please fill out this field. Please enter valid data.

Last Name REQUIRED Please fill out this field. Please enter valid data.

Emergency Contact Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Parent/Guardian Signature REQUIRED Please fill out this field. Please enter valid data.

Relationship to student athlete/s REQUIRED Please fill out this field. Please enter valid data.

Phone Number REQUIRED Please fill out this field. Please enter a phone number.

Email REQUIRED Please fill out this field. Please enter an email address.

*We believe that youth sports should be attainable for all families. For any student who wishes to participate in any sport during the 2023-2024 school year, there is only a one-time athletic program fee in the amount of $30 per student. This fee will be assessed at a later date.