TIGER CONTRACT
Since I have been selected as a member of a Bluffton High School athletic team, I have read and hereby agree to abide by the rules and regulations of the Bluffton High School Athletic Department. I also understand that I must abide by the team rules established by my coach.
Since my son/daughter has been selected as a member of a Bluffton High School athletic team(s), I/we agree that I/we have read the rules and regulations and that I/we will do all that I/we can to help enforce the Tiger Code of Conduct.
Signature of Parent(s)/Guardian(s) Date
AUTHORIZATION FOR RELEASE OF INFORMATION
I request and authorize: Wells County Probation Department, Wells County Law Enforcement Agencies, Wells County Family Centered Services and Wells County Teen Court to release information to: Bluffton High School Athletic Department, #1 Tiger Trail, Bluffton, IN 46714.
Regarding: / D.O.B.Address:
This information is for the purpose of continuity of goals between the student, student’s parents, School Corporation and the above listed Wells County Agencies.
I authorize the above parties to exchange information verbally or in writing concerning probation or supervision rules or activities that may be in violation of the Bluffton High School Athletic Code of Conduct.
I hold harmless Bluffton-Harrison MSD, Wells Community Schools, the Wells County Probation Department, Wells County Law Enforcement Agencies, Wells County Family Centered Services and the Wells County Teen Court or their designees in regard to use of information authorized for release of exchange. I understand that this form may be revoked by me at any time except to the extent that action has already been taken. In the absence of revocation, this consent will expire on the first day of the next school year. I have read and understand the above and acknowledge that it was properly completed prior to my signature. A photocopy of this authorization is as authentic as the original signed Authorization of Release.
Student Signature: / Date:Parent Signature: / Date:
Witness: / Date:
INDIANA PHYSICAL THERAPY
CONSENT FOR AUTHORIZATION
TO RELEASE MEDICAL INFORMATION
I hereby authorize medical consultation and first aid treatment for said athlete at Bluffton High School by the Athletic Trainer(s) assigned to Bluffton High School by the school’s administration. A family member can be reached at ______(phone number) in case that additional treatment or information is required. I authorize the release of any and all information regarding any medical treatment received by said athlete for injury or illness while participating in athletics at the high school of enrollment to the athletic training staff at the school of enrollment. I also authorize the athletic training staff to release said information to the appropriate coach and the school of enrollment for the sole purpose of informing them of playing status.
This authorization is valid until and unless revoked by parent/guardian in writing.
A photocopy of this authorization shall be considered as valid as the original.
Athlete’s Name:______Date:______
Athlete’s Date of Birth:______
Athlete’s Signature:______
Signature of Parent/Legal Guardian:______
Printed Name of Parent/Legal Guardian:______
Parent or Guardian must sign if athlete is under age 18.