ATHLETIC REGISTRATION FORMS To participate in sports at the Burrillville Middle School, the following forms are needed. These must be turned in prior to playing or practicing with the school team. Proof of Physical Examination Each student must turn in a copy of a current (within one year) physical examination signed by a doctor. This must be done once each school year. Students may go to their own physician or the school doctor for a physical. Principal s Committee on Athletics Acknowledgement, Authorization & Assumption of Risk Form (#1) The assumption of risk form must be filled out by all students in grades 6, 7, & 8. This form must be notarized. Medical Insurance Waiver Form (#2) The Burrillville School Department required that all student athletes purchase school insurance. (Information on purchasing school insurance can be found on the BMS website). However, if the student has equal coverage under some other policy, the parent may chose to waive this requirement. To waive the requirement, be sure to fill in the policy number and company name on the form provided. Again, whether you take school insurance or waive it, the form must be notarized. Once the student has completed all these required forms, they need to be turned into the school secretary. If you have any questions, you many call the main office at 568 1320. Burrillville Middle School Waiver Form (#3) This form that is required by the school. Be sure to list every sport you plan to play in the spaces provided on the form. You may write in all sports if you are not sure which sports you will be playing or if you are interested in several sports. This form must be notarized. BMS Substance Abuse Policy Review for Athletes Acknowledgement Form (#4) This form, a review of the school department s Tobacco Policy, P6431 and Alcohol/Substance Abuse Policy, P6432 is required by the school. Burrillville Middle School Waiver Form (#5) This form is an acknowledgement of the BMS Athletic Team Rules. The form must be signed by both student and parent.
PRINCIPALS COMMITTEE ON ATHLETICS GRADES 6 8 Acknowledgement, Authorization and Assumption of Risk Form (#1) Academic Year The undersigned, being an adult student athlete or parent/legal guardian of the undersigned minor prospective student athlete, hereby acknowledge that said student seeks to participate in a student sports program sponsored the Principals Committee on Athletics Grades 6 8. The undersigned specifically assert that said student athlete will comply with the rules and regulations governing athletics participation of the Principals Committee on Athletics Grades 6 8; the undersigned hereby authorize the release of information and reports concerning the academic standing, medical condition, financial aid, attendance record and disciplinary record of the undersigned student to Principals Committee on Athletics Grades 6 8 for the purpose of enforcing the rules and regulations of the athletics program; that they are aware that the athletic participation requires physical fitness; that the student possesses such fitness; and that some risk is involved in sports participation. Now, therefore, pursuant to Rhode Island General Laws 7 6 9, as amended, the undersigned, in consideration of participation in a Principals Committee on Athletics Grades 6 8 sports program, herein grant to its officers, directors, trustees, agents (to include but not limited to the local School Committee or its parochial or private equivalent), servants and employees, a waiver of liability as regards to participation in the sports program sponsored by the Principals Committee on Athletics Grades 6 8. The undersigned specifically acknowledge that a risk of injury exists and assume said risk with respect to practicing for or participating in any contest or exhibition of an athletic or sports matter sponsored by Principals Committee on Athletics Grade 6 8. School (Print) City or Town (Print) Name of Student (Print) Signature of Student Signature of Parent/Guardian Date of Signature Age of Student Current Grade Level Signature of Notary Public SEAL This form must be completed by all students intending to participate in any Principals Committee on Athletics Grades 6 8 sports. All minor students must sign and have a parent or legal guardian also sign. All forms are to be notarized and returned to the school principal. Failure to submit a duly executed form will cause the athlete to be declared ineligible. Only one form for each participant is necessary for the duration of one s eligibility in sports programs sponsored by the Principals Committee on Athletics Grades 6 8.
Insurance Waiver (#2) The Burrillville School Committee requires every student athlete who participates in an interschool sport to have medical insurance with the recognized school insurance plan or comparable insurance with another company recognized by the appropriate state agencies as authorized to write insurance in the State of Rhode Island. As the parent/guardian of the student named below, I understand that if I prefer to purchase my own accident insurance plan, this plan must stay in force during the duration of my child s participation in the athletic program. I also understand that accident insurance is required in order for my child to be able to participate in any Burrillville Middle School athletic program. I further understand that the Burrillville School District, its employees, agents, representatives, coaches and volunteers shall not be held responsible for any additional costs not covered by said insurance. Option #1 I wish to waive the purchase of school insurance of school insurance because my child is covered under a comparable insurance plan. Insurance Company: Policy #: Option #2 I will purchase a recognized school insurance plan. (Information on purchasing school insurance can be found on the BMS website) Student s Name (Please print) Date of Graduation Parent s Signature Date Signature of Notary:
Assumption of Risk (#3) Warning Both the applicant student and parent/guardian must read this carefully and sign this form before the applicant student may participate in the sports program at Burrillville Middle School. Student I am aware that playing or practicing to play/participate in any sport can be a dangerous activity involving many risks of injury. I understand that the dangers and risks of playing or practicing to play/participate in the sport(s) listed below include, but are not limited to death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to the musculoskeletal system and serious injury or impairment to other respects of my body, general health and well being. I understand that the dangers and risks of playing or practicing to play/participate in the sport(s) listed below may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities and generally to enjoy life. Because of the dangers in the sport(s) listed below, I recognize the importance of following the coaches instructions regarding playing techniques, training and other team rules, etc., and agree to obey such instructions. In consideration of the Burrillville School District permitting me to try out for the Burrillville Middle school athletic programs and to engage in all activities related to the teams, including but not limited to trying out, practicing,, or playing/participating in the sport(s). I hereby assume all risks associated with participation and agree to hold the Burrillville School District, its employees, agents, representatives, coaches and volunteers harmless from any kind and all liability, actions, causes of action, depts, claims and demands of any kind and nature whatsoever which may arise by or in my connections with the participation in any activities related to the Burrillville Middle School team(s) listed above. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees and for all members of my family. Signature of Student Signature of Parent/Guardian Please list sport(s) this child will play, or simply write All Sports Signature of Notary (SEAL)
SUBSTANCE ABUSE POLICY REVIEW FOR ATHLETES STUDENT/PARENT/GUARDIAN ACKNOWLEDGEMENT FORM (#4) We recognize that, as educational facilitators, we must be a positive model of good health habits. As educators moving into the 21st Century we see the need to be active rather than reactive. We must provide the best possible physical, intellectual, social, and emotional conditions for our student population as well as our employees and the community at large. It is the intent of the School Committee s Tobacco Policy, P6431 and Alcohol/Substance Abuse Policy, P6432 to protect the health and welfare of children in school, our employees and the community at large by eliminating the exposure to the significant, life threatening health hazard of tobacco, including secondhand smoke, alcohol and other drugs. With this in mind we must adopt Tobacco, Alcohol, and Other Drug enforcement procedures. Athletic Department Substance Abuse Policy Each student accepted to play interscholastic athletics must adhere to the following plan: 1. Attend with a parent/guardian the mandatory substance abuse meeting. 2. Read the Alcohol, Tobacco and Other Drug Policy found in the BMS handbook. 3. Complete the student/parent Acknowledgment Form and submit it to the Middle School Principal For all students BMS wants you to remember: I f you are on academic probation, you can t play sports for the first ten days of AP. After ten days, you may get an AP form from the House Office and have your teachers sign it. If it states that you are passing all but one of your classes at that time, then you may rejoin the team. If you are on behavior probation, you are not allowed to play sports for 30 days (from the date of the school suspension). BMS doesn t have a personality; YOU give our school a personality! When you are in uniform, on or off of the field/court/mats you need to remember you are representing our school! Please do not argue with your coaches, referees or umpires. I have reviewed the Athletic Department Substance Abuse policy with my child and will encourage my student athlete to be substance free. Parent Signature Parent Name (Please print) Date Student Signature Student Name (Please print) Date Please submit this form to the main office ASAP
Mustang Team Rules Keep it Simple : Be a responsible player and person. Be honest. Be on time. Use common sense. Give 100% at all times. Our final score will be determined by the effort we each make doing it the Mustang Way. Expectations 1. School It is the player s responsibility to comply with all school rules as defined in the Student Handbook. a. Students must meet all BMS and RIPCOA eligibility requirements in order to play. b. Attendance: If a player is not in school as required, they may not practice or play in a game. Players missing practice the day before a game will not be able to play in that game. c. Players may be late to or miss a practice or game due to school related issues only, without penalty. It is the player s responsibility to gain approval from the coach in advance. Players missing practice for detention or suspension from school may face suspension from games. d. Players missing games for family vacations, work, social events, or other non school related activities will miss an equal number of games when they return. 2. On Field : Players report to games, practices, team meetings and meetings with coaches on time, with the proper equipment and clothing for ever changing weather. a. If you are going to be late or absent, it is your responsibility to notify your coach in advance for approval. If you stay for extra help with a teacher, bring a note from the teacher. b. You must have permission to leave any team or individual session. 3. Socializing : Socializing will be kept to a minimum any time you are on the field/court/ice. You are not allowed to socialize to any parent, friend, etc. as your concentration should be on the game with the team. 4. Sportsmanship : Positive sportsmanship is the rule for everyone on the field. a. Coaches, players and parents are not allowed to vocalize, comment, or gesture in any way to opponents, fans or GAME OFFICIALS. Negative comments do not help the team in any way. Any such disturbance will be cause to have you removed from the field. b. Coaches, players and parents will not use demeaning, taunting, vulgar and/or abusive language. In addition, players are not allowed to throw any equipment in disgust. All must face adversity unemotionally. 5. Care of Persons & Personal Items : Theft or horseplay involving any team or teammate s personal items or equipment will not be tolerated. Hazing of any type is prohibited! 6. Injuries : Injuries must be reported to the coach. Coaches will file an injury report with the athletic department as required by the school.
7. Transportation : BMS policy requires all players to ride the bus to and from all games. It is important to stay together as a team. In special cases, a player will be allowed to ride home with his or her parent only and only with the permission of the coach. The player must submit a note to the BMS main office clerk the day of or earlier, if possible the game. The clerk will verify the request with the parent then give the note to the coach. 8. Philosophy Regarding Playing Time : All sports are competitive in nature. As such, playing time is determined by coaches selecting the best players and best line up to put the team in a position to be successful. The team always comes first! a. No player is guaranteed a starting position or playing time! b. Positions and playing time must be earned in practices, game situations and by displaying positive attitudes. c. All players regardless of year in school will have an equal opportunity to earn playing time. Those with the best skills and knowledge of the game will play. 9. Non School Competition and Loyalty to School Team : If a conflict arises between the middle school team practice/competition and an out of school practice/competition on the same day, the middle school team practice/competition must be honored by the student athlete. Priority/loyalty must be given at all times to the middle school team practices and contests unless a waiver has been granted by the principal and athletic director on a case by case basis. 10. Discipline : Violations of team rules may result in suspension of games or dismissal from the team. Where necessary, based on the severity of the action, coaches will consult with the athletic director and/or the middle school administrator prior to taking action. Extenuating circumstances will always be considered prior to suspension or release from the team.
BURRILLVILLE MIDDLE SCHOOL ATHLETIC TEAM RULES STUDENT/PARENT/GUARDIAN Acknowledgement Form (#5) I have read and reviewed the TEAM RULES with my son/daughter, and we agree to abide by them. STUDENT NAME: Please print clearly STUDENT SIGNATURE: PARENT/GUARDIAN SIGNATURE: SPORT: DATE: If playing multiple sports during the school year, write all sports. Please submit this form to the main office ASAP