State Tournament Eligibility  & Medical Release Form

To be eligible to play, all players must turn in a signed form!!!! Players without forms, will not play!!!

To print a one page document. Please print form in PDF or Word formats!

Team Name:

Please print!!!

 

 

  

Players Last Name

First Name

Jersey #

Grade

Birth Date

Age

 

Telephone

Street Address

City

MI

Zip Code

  

Parental Information

  

Parents Last Name

Fathers First Name

Mothers First  Name

  

Father's place of employment

Address

 

  

Work Number

Ext.

Cell Number

  

Mother's place of employment

Address

 

  

Work Number

Ext.

Cell Number

  

Emergency And Medical Information (Emergency Contact: other than parent)

  

Last Name

First Name

Relationship

Phone

  

Last Name

First Name

Relationship

Phone

  

Family Doctor

Phone:

  

Hospital Preference:

Insurance Company:

  

Policy/contract number:

Group Number:

  

Medication/Food allergies:

  

Other Medical conditions that the tournament director should know.

  

Homeschooling

Participants must be Homeschooled more than 51% of their classes each year. Participants must maintain pursuit of their education and the majority of their educational effort must be directed toward home school instruction with a minimum of three subject areas not including extracurricular athletic endeavors. Any team that allows players, who do not meet the minimum eligibility criteria, to participate in the State  Tournament will not be allowed to participate in next year’s State Tournament. And will be dismissed from these tournaments with no refund.

Home-schooled means:

·          Taught at home by one of more of the student’s parents or grandparents; or

·          Taught at home by an older (18 or older) sibling; or

·          Taught at home by a legal guardian; or

·          Taught at home, or someone else’s home, by another homeschool parent or tutor, provided that it is done under the direction and supervision of the child’s parent; or

·          Taught at a central location for a particular subject (such as chemistry, speech or calculus) by a homeschool parent or tutor; or

·          Correspondence or online course; or

·          Tutored classes taught at programs like TeenWorks or Grace Academy

Home-schooled does NOT mean:

·          College classes taken at a University or College; or

·          Vocational/Technical classes taken outside the home; or

·          Classes taken at a Private, Christian or Public School

Other Criteria

·          Player must be a live-in dependent of one of their parents (or legal guardians).

·          Player must NOT be employed full-time (40 hours per week).

·          Player must NOT be graduated from High School level education.

·          Player must NOT have been expelled from public or private school during the school year of the current sports season.

·          Player must NOT be eligible to play in another sports league (public or private school).

·          Player must be 18 or younger. Age (as of September 1st of the current season) Varsity

·          Player must be 16 or younger. Age (as of September 1st of the current season) Jr. Varsity

 

Emergency Authorization:  I hereby give permission for my above-named minor child to receive medical and/or emergency surgical treatment and/or transport. Non-emergency medical treatment or elective surgery is not included in this authorization.  We understand that ECHO/LAHAA is a volunteer program and will not hold the organization responsible for injuries that may occur while participating.

 

Agreement:  I have read the above emergency authorization and the homeschooling criteria and fully understand the terms of each. By signing this I agree to these terms, and I do so freely and voluntarily and without inducement for myself and on behalf of the above player.  I certify that the information I have provided above is true and correct to the best of my knowledge.

                                                                                                                                   

Parent’s (or legal guardians) Signature__________________________________________________________________ Date___________________