Long Valley Middle School - Athletic Participation Checklist

Long Valley Middle School - Athletic Participation Checklist

This form serves as a checklist of items that are required for participation in our Interscholastic Sports Program at Long Valley Middle School. Please note that some forms are optional and do not need to be returned. Additionally, we ask that you review policies and health information that are located on our school website. This information can be found at Go to the “Students” tab and scroll down to “Athletics.” Please return this completed sheet, along with a completed Physical Form or Health History Form. Any incomplete forms will be returned to parent/guardian.

Health History and Physical– good for 365 days– I understand that one complete Health History and Physical is required each year (every 365 days) in order for my son/daughter to participate on a school sponsored sports team. Physicals are conducted by the student’s private physician, or advanced practice nurse. If a student does NOT have a private physician or is without medical insurance please contact Mrs. Meara, school nurse, at 908-876-3434 Ext. 2306. All History and Physical Forms must be reviewed by our school doctor prior to participation in tryouts or sports.

Health History Update– This form is to be completed ONLY if the physical is over 90 days old. I understand that a Health History update is ONLY required prior to each season if physical is over 90 days old.

The Athlete with Special Needs (optional)– (page 2 of physical form)Complete this page ONLY if child has disabilities requiring special accommodations to participate in sports.

Eligibility Consent – I, along with my son/daughter, whose signature appears below, acknowledge that we have read the Washington Twp. Schools Extracurricular Activities Eligibility Policy and agree to adhere to all rules as outlined.

Cardiac and Concussion Brochures – I, along with my son/daughter have read and understand the basic facts of sudden cardiac death in young athletes as well as the CDC brochure on concussion injuries found on the LVMS web site.

Sports Permission Consent– I, along with my son/daughter, whose signature appears below, acknowledge the physical hazards that may be encountered in sports activities, and I give my permission for him/her to try out for ______(list one sport) and be transported to and from any away competition(s).

All items must be checked along with parent/guardian/student signatures before your child may begin to participate for the current sport season.

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Parent/Guardian Signature Date

Email Address - to acknowledge clearance of physical: ______

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Student-Athlete’s Name / GradeDate

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Student-Athlete SignatureDate

Long Valley Middle School – Pay to Participate Programs

Any student who makes an interscholastic sports team must immediately submit a check, in the amount of $85.00,

payable to the Long Valley Middle School, to his/her coach. Your check will be your receipt.

Returned checks will not be re-deposited by the school district.

Payment will not be accepted until the tryout process is completed.

Please note: All extra and co-curricular programs must meet minimum enrollment criteria to operate. If a minimum number of students do not sign up for a sport, activity, or club, as determined by school administration, the district has the right to cancel the program. All fees for athletics, activities, or clubs are NON-REFUNDABLE unless the school cancels the program.