Student Cross Country Paperwork

STUDENT CROSS COUNTRY PARTICIPATION AND MEDICAL CONSENT FORM

Participant Information

Student Name:

Date of Birth:    Student ID:

Parent / Guardian Information (if participant is a minor)

Emergency Contacts

Medical Information & Authorization

Participation Agreement, Assumption of Risk, and Release

I certify that Student Name: is physically capable of participation in cross country training and competition. I understand that participation involves strenuous exertion and exposure to natural terrain, weather, and traffic patterns. I acknowledge and assume all inherent risks, known and unknown, associated with cross country activities, including but not limited to falls, collisions, cardiac events, heat illness, concussion, and communicable disease exposure.

In consideration of being permitted to participate, I, on behalf of the participant and our heirs, executors, and assigns, hereby agree to release, waive, indemnify, and hold harmless the school, district, coaches, employees, volunteers, and agents from any and all claims, liabilities, demands, causes of action, or expenses arising out of participation, except to the extent caused by gross negligence or willful misconduct.

Medical Treatment Authorization

If emergency medical treatment is necessary, I authorize the coach, team representative, or medical personnel to secure and administer treatment, including hospitalization and surgery, and I agree to be financially responsible for such treatment. I understand that reasonable efforts will be made to contact the emergency contacts listed above prior to treatment when feasible.

Transportation Consent

I authorize transportation of the participant by school-approved vehicles or designated private vehicles to and from meets, practices, and related activities. Transportation by parents or third parties arranged by the school requires separate authorization when requested. I understand that the school and its agents are not responsible for non-school transportation arrangements not approved in writing.

I consent to school-approved transportation to and from team events.

Photo/Media Release

I authorize the school and its representatives to photograph or record the participant for purposes related to athletic programs, publicity, or educational records. Permission is not required for routine team rosters or game statistics.

I grant permission for photo/video use.    I do not grant permission for photo/video use.

Concussion & Head Injury Acknowledgement

I acknowledge that I have received and read information regarding concussion and head injury, including signs and symptoms and return-to-play protocols. I understand that the participant must be removed from activity if a concussion is suspected and must receive written medical clearance before returning to full participation.

I acknowledge receipt of concussion information and agree to follow protocols.

Code of Conduct and Training Expectations

The participant agrees to comply with all team rules, safety instructions, conditioning expectations, and directions of coaches. Failure to adhere to rules may result in suspension or removal from the team. Use of illegal substances, hazing, or conduct detrimental to team safety or reputation may subject the participant to disciplinary action.

Additional Information

Acknowledgment and Signature

By signing below, I certify under penalty of perjury that the information provided in this form is complete and accurate to the best of my knowledge. I further acknowledge that I have read and understand the foregoing statements, that I have been given the opportunity to ask questions, and that I accept the responsibilities described herein. This agreement is binding on the undersigned and our heirs, representatives, and assigns.

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