Student – Athlete Eligibility Packet Technology High School Athletic Department 2019-2020
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Student – Athlete Eligibility Packet Technology High School Athletic Department 2019-2020 Student Name:__________________________ Sport:_________________________ Returning student: yes / no New/Transfer Student: yes / no Incoming 9th Grader: yes / no (If yes) Name of Middle School__________________ Packet Contents: Checklist for meeting athletic eligibility requirements List of Sport Offerings Athletic Code and Philosophy CIF/NCS/CMC/SCL eligibility regulations THS academic eligibility regulations Athletic Department regulations/disciplinary policy Risk of participation warning Procedure for filing a complaint against a coach Points of emphasis regarding athletic competition NCAA Freshmen Eligibility Standards (New for the college bound athlete) Part 1. 1-10 must be completed before the first day of practice 11 & 13 must be completed before the first contest 1. ___ Personal Information 2. ___ Sport of Participation 3. ___ Evidence of physical examination (completed after 6/1/19 – Good for 1 year) 4. ___ Medical Insurance Verification (including policy number) 5. ___ Parent/Guardian information 6. ___ Parent/Guardian permission to participate / medical consent 7. ___ Acknowledgement of athletic code and requirements 8. ___ NCS ejection policy acknowledgements form 9. ___ Sportsmanship pledge form 10. ___ Parent/Guardian/Athlete use of steroids form 11. ___ New or Transfer students to THS (see Athletic Director) 12. ___ Signed concussion form 13. ___ Completed Parent Driver Form (continued on next page) Part 2. Checklist for meeting eligibility requirements 14. ___ Submitted completed eligibility packet to the Athletic Department 15. ___ Student received a 2.0 grade point average in last grading period. If not a student is eligible for to athletic / academic waivers throughout their four years of high school. *See Athletic Director for requirements 16. ___ Must have passed a minimum of 20 units of coursework in the previous grading period (this requirement can not be waived 17. ___ Must have not previously participated in high school sports at another high school or has submitted an application for waiver of ineligibility 18. ___ Must be enrolled in THS for at least semester 20 units of coursework 19.. ___ Must have completed eighth grade and not more than eight semesters of high school 20. ___ Must not have reached 19th birthday prior to June 15th of the school year 21. ___ Must not violate the CIF amateur status rule 22. ___ Must not have participated in more than four seasons of any one sport during four years of high school 23. ___ Must not be competing on an outside time in the same sport during the student’s high school season of sport 24. ___ Must agree to abide by the regulations of the athletic department as set forth in the athletic code Technology Titans Technology Athletic Department Participation Clearance Form 2019-2020 Section 1: Section 2: Name – Last, First (print clearly) Check sport(s) of participation _______________________________ Fall Winter Spring Birth date: ( ) Cross Country (coed) ( ) Boy’s Basketball ( ) Baseball ( ) Boy’s Soccer ( ) Girl’s Basketball ( ) Golf (coed) Grade: ( ) Girl’s Volleyball ( ) Dance Team ( ) Swimming (coed) th th th th ( ) 9 ( ) 10 ( ) 11 ( ) 12 ( ) Girls Soccer ( ) Tennis (coed) ( ) Track/Field (coed) ( ) Softball Entry Date at THS: (month/year) Previous High School: (if any) Section 3: Section 4: Evidence of Physical Examination Medical Insurance Verification (separate form signed by doctor may be attached) ($1500 minimum required) Supplementary insurance may be purchased. See THS office. I hereby certify that the above named student was Examined by me and was found to be physically Insurance Company: _____________________________________ fit to engage in interscholastic athletics Policy Number: _________________________________________ Are there any apparent cavities in teeth? _____ I will purchase supplementary medical insurance if I am not covered Does the patient have a bridge or any false teeth? _____ ( ) yes ( ) no _____ If needed, the supplementary insurance form must be submitted to the Any other condition that should be watched? Athletic Director. See the school office for forms. Physician’s Signature: ________________________ Date:_______ Section 5: Section 6: Parents / Guardian Information Parent / Guardian Consent: Medical Treatment / (Please Print Clearly) Permission to Participate Name: My child has my permission to participate in interscholastic Last, First_________________________________ athletics. I request that my child receive first aid services whenever such Services are deemed necessary. I authorize that my child be attended by Telephone: licensed physician and/or be taken to the nearest hospital in the event that Such treatment is deemed necessary. I will accept the judgment of the Home:______________ Work:_________________ person in charge of the activity. I further acknowledge that I have read and understood the warning to students and parents section concerning Cellular:_____________ Pager: ________________ the risks involved with participation in interscholastic athletics. I give my permission to receive first aid services whenever necessary. Address: Street:____________________________________ Parent/Guardian Signature _____________________________________ (Date) City: ___________________ Zip: ______________ Student-Athlete Signature ______________________________________ ________________________________________________________________________________________________(Date)______ Section 7: We hereby acknowledge that we have read and understand the THS athletic code, including the philosophy and regulations that govern the behavior of athletes while attending Technology High School and participating in the sports program. We also acknowledge that we have read and understand all THS, CMC, NCS, and CIF academic, athletic, citizenship and residential requirements included herein and agree to abide by them. _________________________________________________ ___________________________________________________ (Parent/Guardian Signature) (Date) (Student-Athlete signature) (Date) COTATI-ROHNERT PARK UNIFIED SCHOOL DISTRICT AGREEMENT FOR STUDENT ATHLETE AND PARENT/GUARDIAN REGARDING USE OF STEROIDS (Acuerdo para estudiantes atletas y sus padres/tutores legales respecto al uso de esteroides.) Student Athlete’s Name (Nombre del estudiante) ___________________________ Directions: As a condition of membership in Direcciones: Como condición de ser socio de la the California Interscholastic Federation federación inter-escolástica de California (CIF), the Governing Board of the Cotati- (California Interscholastic Federation =CIF), la Rohnert Park Unified School District has Mesa Directiva del Distrito Escolar Unificado de adopted Board Policy 5131.63 prohibiting the Cotati-Rohnert Park ha adoptado la Política use and abuse of androgenic/anabolic 5131.63 prohibiendo el uso y el abuso de steroids. CIF Bylaw 524 requires that all esteroides andrógenos/anabólicos. La ley 524 de participating students and their la CIF requiere que todos los estudiantes parents/guardians sign this agreement. participantes y sus padres/tutores legales firmen By signing below, we agree that the student este acuerdo. shall not use androgenic/anabolic steroids Con nuestra firma abajo, acordamos que el without the written prescription of a fully estudiante no usará esteroides licensed physician, as recognized by the andrógenos/anabólicos sin la receta de un American Medical Association, to treat a medico licenciado, reconocido por la medical condition. asociación médica americana (American We recognize that under CIF Bylaw 200.D the Medical Association), para el tratamiento de student may be subject to penalties, including una condición médica. ineligibility for any CIF competition, if the Reconocemos que bajo la ley 200.D de la CIF el student or his/her parent/guardian provides estudiante puede ser penalizado, incluso ser false or fraudulent information to the CIF. descalificado de participar en cualquier We understand that the student’s violation of competición de la CIF, si el estudiante o su the district’s policy regarding steroids may padre/madre/tutor legal proporcionan result in discipline against him/her, información falsa o fraudulenta a la CIF. including, but not limited to, restriction from Comprendemos que la violación de la política athletics, suspension, or expulsion. distrital acerca de esteroides puede resultar en consecuencias disciplinarias, incluso, pero no limitadas a la restricción de actividades atléticas, o la suspensión o expulsión escolar. ________________________________________ _______________ Signature of student athlete (firma del estudiante) Date (fecha) _________________________________________ ________________ Signature of parent/guardian (firma de padre/tutor) Date (fecha) 8/05 SteroidsStudentParentAgreement-ENSP ATHLETE EJECTION POLICY NOTIFICATION FORM* (North Coast Section Ejection Policy) Technology High School The following rules and minimum penalties are applicable to players as adopted by the NCS Board of Managers on April 21, 1995. This policy will be in effect beginning with the 1995-96 school year, (and will include non-league, league, invitational tournaments/events, post-season; league, section or state playoffs, etc). 1. Ejection of a player from a contest for unsportsmanlike or dangerous conduct. Penalty: The player shall be ineligible for the next contest (non-league, league, invitational tournament, post-season {league, section or state}