Name Graduation Year Sport AHS ATHLETIC PACKET Athletic packet instructions/checklist Physical/Consent/Proof of Insurance We must receive a doctor signed physical/consent/proof of insurance form each school year before you will be allowed to practice or participate. This form will be good for the entire school year. Athletic Eligibility/Transfer Eligibility NCS Ejection Policy and Agreement Alcohol/Tobacco/Drug Non-Use Agreement (District Requirement) Steroid Non-Use Agreement (NCS/CIF Requirement) Consent to Release Information (Optional) Sports Fee Please be sure to write athlete s name and sport on your check. $150 per athlete, per sport (Two sport fees max, per athlete each school year) $600 family maximum per year Transportation & Waiver Form - Required when transporting athletes. In addition to the transportation and waiver form, a copy of the transporters driver s license must be on file, as well as a current copy of their insurance policy. Required insurance coverage is as follows: Bodily Injury $100,000/$300,000 Property Damage $ 50,000 Medical Payment $ 5,000 Parents transporting only their children do not need to meet MUSD s required insurance coverage. However, parents must have proof of insurance and driver s license on file with the athletic office. 5/3/10 cb Page 1 of 9
STUDENTS NAME GRADUATION YEAR ATHLETIC ELIGIBILITY In order to encourage and promote academic excellence, all students planning to participate in athletics at Alhambra High School shall demonstrate satisfactory minimum progress in meeting the requirements for graduation by undertaking the prescribed course of study (4 classes minimum) and meeting the standards of proficiency established by the district. 1. Have a valid physician s statement, proof of insurance, and parent consent form on file with the Athletic Department. 2. Complete and return the NCS Ejection Policy form, AHS drug and alcohol policy form, and sports fee to the Athletic Department or Student Body Accounts. 3. To be eligible a student must have at least a 2.0 GPA each grading period and be enrolled in and passing at least 20 semester units (4 classes) of work. A student may go on probation only once during the academic school year. To go on probation, a student s grades must be between a 1.67 and a 1.99 GPA. With approval of both the coach and parent, ineligible students may continue to practice, but may not be on the sidelines of any game or scrimmage. Ineligible athletes will not be allowed to attend any team function other than practice. Ineligible athletes must maintain a 2.0 the next grading period to become eligible. Grades earned in summer school will be averaged into the spring semester grades to determine eligibility for fall sports. a. The season of sports extends through post season play. b. Loss of eligibility means the students will turn in all equipment and uniforms, and will forfeit all awards, including a letter. 4. Students must attend all classes they are scheduled in on the day of any practice or game to be eligible to participate. Medical or legal appointments may be an exception to the rule if clearance is granted by the school administration. ATHLETIC TRANSFER ELIGIBILITY It should be fully understood the agreements of legal attendance with the school district in the Tri-County Athletic League (DFAL) do not automatically assure athletic eligibility. The legal right to attend a particular school and athletic eligibility are separate entities and therefore, are governed by two totally different authorities. 2200.1 A student who transfers from a school located in the United States, a U.S. Territory, a U.S. Military Base or Canada (to be referred to as school A to School B, without a change of residence on the part of his/her parents, legal guardians or caregiver with whom the student was living with when the student established residential eligibility from school attendance are A to school attendance area B, shall be ineligible for all sports for one calendar year. If a student transfers from another high school to Alhambra High School, the student s athletic eligibility will not be cleared until the Athletic Director and Coach have reviewed and cleared the athlete s transfer eligibility status. Failure on the part of the athlete to report his/her change of residence to the school administration of the school he/she is attending may result in: 1. Forfeiture of all contests won by the team on which the ineligible student played. 2. Athletic ineligibility status for the athlete for at least one calendar year in any California senior high school even though he/she is allowed to remain in that school. Parent/Guardian Signature: Student Athlete Signature: Page 2 of 9
NCS Ejection Policy These rules and minimum penalties are applicable to players during the time that officials have jurisdiction for the contest in accordance with National Federation rules for the respective sport. 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] playoff, etc.). 2. Illegal participation in the next contest by a player ejected in a previous contest Penalty: The contest shall be forfeited and the ineligible player shall be ineligible for the next contest. 3. Second ejection of a player for unsportsmanlike or dangerous conduct from a contest during one season. Penalty: The player shall be ineligible for the remainder of the season. 4. When one or more players leave the bench to begin or participate in an altercation. Penalty: The player(s) shall be ejected from the contest-in-question and become ineligible for the next contest (non-league, league, invitational tournament, post-season [league, section or state] playoff, etc.). Each league shall establish a procedure for reporting ejections. Examples would include: 1. the officials shall report (orally or in writing) to specified school personnel and/or league commissioner, 2. the coach of the ejected player s team shall notify (orally or in writing) the principal of the ejected player s team and/or the league commissioner, or 3. the coaches of both teams involved shall notify (orally or in writing) the principal of the ejected player s team and/or league commissioner. APPEALS Only appeals related to the factual situation of the player s ejection will be heard. Such appeals will only be made to penalties related to subsequent penalties after the ejection, they will not have jurisdiction to change the status of the player s ejection from the game in question. No appeal will be heard related to the official s judgment (other than an incorrect identification). Appeals shall be heard initially through the ejected student s league, subsequent appeals may be made through the applicable North Coast Section, CIF and State CIF appeals procedure. NOTICE Every player and coach must read and sign a copy of the NCS Ejection Policy rule. The copies will be maintained by each school s administration. Each school s principal must send a statement to the NCS or league office prior to the first contest of the season verifying that all players and coaches for the respective season (fall, winter, spring) have read and signed the NCS Ejection Policy rule and that any future additions (either players or coaches) will also do so prior to participating in an interscholastic contest. I have read and understand the rules and regulations of the NCS Ejection Policy. Athletes may not participate in any contest until this document is filed with the school. Student s Signature Parent/Legal Guardian Signature Sport Varsity JV FS FR Page 3 of 9
ALHAMBRA HIGH SCHOOL / MARTINEZ UNIFIED SCHOOL DISTRICT ALCOHOL / TOBACCO / DRUG NON-USE AGREEMENT FOR STUDENT COMPETITORS / PREFORMERS Student s Name Sport/Program 1. As coach/advisor of this sport/activity I recognize that participants have the responsibility of representing AHS/MUSD in and outside of school. These students are peer leaders and role models. I am aware that those I supervise must be at their physical and mental best in order to reach their full potential. Taking on the responsibility of representing AHS/MUSD requires each participant to adhere to the AHS/MUSD alcohol, tobacco, and drug policy of no use of alcohol, tobacco or illegal drugs. Therefore, I expect those I supervise not to use or possess alcohol, tobacco or drugs (unless legally prescribed) at any time during the school year as specified in the policy regulations, I also accept my responsibility to assist students in adhering to the AHS/MUSD policy and to refer students needing substance abuse assistance to the proper resources. Coach/Advisor Signature 2. As parent/guardian of this student I am aware of the AHS/MUSD policy of no unlawful use of alcohol, tobacco or drugs. I recognize that my son/daughter represents not only himself/herself but also AHS/MUSD as a participant in this program, and therefore must adhere to the AHS/MUSD policy. I understand my son/daughter has been informed of the policy which prohibits the use of alcohol, tobacco and drugs ( except those legally prescribed ) at any time during the school year, on or off campus, including weekends, holidays, vacations and evenings as specified in policy regulations. Parent/Guardian Signature 3. As a student participant in this program, I acknowledge receipt and understanding of the AHS/MUSD policy regarding the unlawful use of alcohol, tobacco and drugs. I understand that I am expected not to use or possess alcohol, tobacco or drugs (unless legally prescribed) at any time during the school year, on or off campus, including weekends, holidays, vacations and evenings as specified in the policy regulations. I understand what the consequences are should I choose to involve myself with any of the above. The consequences for violating this agreement are spelled out in the student handbook and MUSD drug policy. Student Signature Page 4 of 9
ALHAMBRA HIGH SCHOOL 150 E Street Martinez, CA 94553 Print Name of Student Athlete As a condition of membership in the CIF, all schools shall adopt policies prohibiting the use and abuse of androgenic/anabolic steroids. All member schools shall have participating students and their parents, or legal guardian/caregiver, agree that the athlete will not use steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition (Bylaw 524). By signing below, both the participating student athlete and the parents, or legal guardian/caregiver, hereby agree that the student shall not use androgenic/anabolic steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition. We also recognize that under the CIF bylaw 200.D., there could be penalties for false or fraudulent information. We also understand that the Alhambra High School/Martinez Unified School District policy regarding the use of illegal drugs will be enforced for any violations of these rules. Signature of Athlete Signature of Parent/Caregiver Page 5 of 9
Alhambra High School 150 E Street Martinez, CA 94553 (925) 313-0440 Fax (925) 229-2097 Student-Athlete Consent to Release Information Form I,, authorize Alhambra High School Counseling Please print parent/legal guardian name Department to release my student-athlete s transcript to any college/university that is requesting information on my son/daughter:. Please print student name I understand that I have the option to revoke this consent at any time. Parent Signature: Students Name: : Note: Student-Athletes should visit the NCAA website at www.ncaa.org to complete the NCAA clearinghouse. Page 6 of 9
MARTINEZ UNIFIED SCHOOL DISTRICT CERTIFICATE OF ACCIDENT INSURANCE, PARENT CONSENT, AND PHYSICIAN S STATEMENT NAME Male/Female DATE OF BIRTH ADDRESS HOME PHONE HT WT Is your child covered by State required medical/hospital insurance in the amount of $ 1500.00? Yes/No Name of Coverage If no: I will purchase coverage for my student (available at school) I UNDERSTAND THAT THE SCHOOL DISTRICT DOES NOT PROVIDE ACCIDENTAL DEATH/HOSPITAL OR DENTAL INSURANCE. In case of an emergency, notify: Parent/Guardian Home # Work # Cell # Parent/Guardian Home # Work # Cell # Emergency name Home # Work # Cell # Family Physician Phone # List any medication(s) student is allergic to: List any medication(s) student takes regularly for any health condition: List chronic medical conditions (i.e. diabetes, epilepsy, asthma, heart condition, etc.: List any past injuries or surgeries school should be aware of: I hereby give my consent for my student to compete in interscholastic athletics and to go with a representative of the school on any trips. If my student is injured, MUSD personnel are authorized to have him/her treated. PREFERRED TREATMENT SITE/HOSPITAL: I hereby certify that the above information is correct. Mother s signature Father s signature I hereby certify that has been seen by me for a complete physical examination on, 20, and has been found to be physically fit to engage in interscholastic athletics for the school year 20. If the above named student has any injury or physical condition that should be watched, please list: Physician s signature Revised Page 7 of 9
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AHS Boosters Club Membership Form 2010-2011 Last name of student(s) currently attending First name(s) Address City Zip ( ) Phone Mother s Last Name First Name E-mail address (used for Booster s announcements and updates only) Phone (if different from above) Father s Last Name First Name E-mail address (if different from above) Phone (if different from above) PLEASE CHOOSE YOUR LEVEL OF SUPPORT Bronze = $30 Includes an enthusiastic thank you & a Dogs athletic sticker Silver = $60 Includes a sports bottle & a Dogs athletic sticker Gold = $100 Includes 5 entries to home sporting events, a sports bottle & a Dogs athletic sticker Platinum = $250 Includes a Dogs stadium chair, 10 entries to home sporting events, a sports bottle & a Dogs sticker If you would like a receipt for tax deduction purposes, please ask us. MAKE CHECKS PAYABLE TO AHS BOOSTERS NOTE: prizes subject to change, but will be of equal or greater quality PLEASE CHOOSE THE SEASON YOU WOULD BE WILLING TO WORK ONE EVENT FOR A FEW HOURS AS ANOTHER WAY TO SHOW YOUR SUPPORT OF AHS SPORTS FALL WINTER SPRING ---------------------------------------------------------------------------------------------------------------------------- ESCRIP IS VERY IMPORTANT TO OUR SCHOOL ACTIVITIES PLEASE REGISTER You can register online at www.escrip.com If you register online you will need the AHS Booster s Group ID #: 5017957 If you would also like to support AHS PTSA use Group ID#: 150239927 (If you enroll under Booster s Group ID, we will contact you to verify which sport you want to support) Page 9 of 9