Canyon High School

Summer Athletics Program

Registration Procedure

The 2010 Summer Athletics Program will be held at Canyon High School and will consist of three to six week

camps depending on the sport you choose. You must complete all sections of each

form before your child can register and participate in interscholastic athletic practices and contests.

Registration Form Check List

Please complete the following:

ü Registration Form

Return your “Registration Form” with payment to the ASB Office or register online at www.hartdistrict.org/canyon. Under this portion, please visit “Store” and follow the provided instructions.

Registration deadline is June 11, 2010. $25 late fee after June 11.

ü Athletic Clearance Form

ü Canyon Sports Web-Site Consent / Release from Team Bus

ü Code of Ethics - Athletics Form

ü Certificate of Physical Examination

ü Athletic Emergency Form

Registration Information

Please fill out the following forms completely and submit them to the ASB Office and your coach. Attached in this packet is a list of all camps and information regarding the days they meet, time, and location.

There is no requirement of enrollment in a summer athletic camp to be on a team. Enrollment in a summer athletic camp does not guarantee making an athletic team. Families may take summer vacations during

summer athletic camps. If you have any questions about each camp please contact the contact coach using the information provided on that form. Refund / cancellation deadline is five days after the starting date

of the first camp. A $25 administrative fee will be withheld. Registration deadline is June 11, 2010. A $25 late fee will be charged for students who turn in their registration form after June 11.

REGISTRATION DEADLINE - JUNE 11, 2010

SUBMIT YOUR REGISTRATION FORM TO THE ASB OFFICE

OR REGISTER ONLINE AT THE PROVIDED WEBSITE DESCRIBLED ABOVE.

Canyon High School

Summer Athletics Program

REGISTRATION FORM

Student Information

Student’s Full Name: ____________________________________________________________

Students ID Number (ex. 98001577): _________________________________ Grade: __________

Home Phone Number: ___________________________________________________________

Camp Information

Circle any camps you are interested in participating with this summer:

Boys Basketball (V) - $115 Boys Basketball (JV) - $115 Boys Basketball (F) - $115 Girls Basketball (V) - $115 Girls Basketball (JV/F) - $115 B & G B-ball Shooting Inst - $80 Baseball (Returners) - $110 Baseball (F) - $110

Football (V) - $115 Football (JV) - $115 Football (F) - $115 Girls Soccer (All) - $110 Boys Soccer (All) - $110 Boys Volleyball (All) - $110 Girls Volleyball (V) - $110 Girls Volleyball (JV/F) - $110

Cross Country (All) - $115 Softball (All) - $110 B & G Tennis - $100

Payment Information

Mark all camps that you wish to register for and enclose the full amount of money.

Please pay by check, money order or by credit card online at www.hartdistrict.org/canyon Go to “Store” and follow provided directions.

Total Amount Paid: _____________ Check Number #: _____________

Checks Payable To: Canyon High School ASB

Cancellation deadline is five days after the starting date of the first camp

Please return packet with money and completed information to your contact coach or ASB Office.

Canyon High School

Summer Athletics Program

ATHLETIC EMERGENCY FORM

Student Information

Student’s Full Name: _______________________________________________________________ ___

Students ID Number (ex. 98001577): ______________________________________ Grade: ___________

Home Phone Number: _____________________________________________ Birth Date: ___________

Address: _________________________________________ City: _______________ Zip: ___________

Parent Information

Father: __________________________ Work # ___________________ Cell # ___________________

Mother:__________________________ Work # ___________________ Cell # ___________________

In an emergency (if parents cannot be reached) notify:

1. ______________________________ Phone # ___________________ Cell # ___________________

2. ______________________________ Phone # ___________________ Cell # ___________________

3. ______________________________ Phone # ___________________ Cell # ___________________

Name of Insurance Company ______________________________________ Policy # ______________

Family Doctor _____________________________________________ Phone # ___________________

NOTE: Please state any pertinent medical information coaches or physicians should know about the student-athlete.

(Allergies, medications, or conditions that require immediate emergency treatment such as Epi-Pen, Glucagon, inhalers, etc.)

____________________________________________________________________________________

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination or immunizations

for the above-named student. In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury,

I understand that an attempt will be made by the attending physician to contact me in the most expeditious way possible. If said physician is not able

to communicate with me, the treatment necessary for the best interest of the above-named student may be given. Permission is also granted to the

Certified Athletic Trainer to provide the needed first aid treatment prior to the student’s admission to any medical facility.

Parent’s / Guardian’s Signature _________________________________ Date ______________

Canyon High School

Summer Athletics Program

ATHLETIC CLEARANCE FORM

You must complete all sections of this form before your daughter / son can participate in interscholastic athletic practices and contests.

Warning to Student-Athlete and Parents:

By nature, competitive athletics may put students in a situation where SERIOUS, CATASTROPHIC, and perhaps, FATAL ACCIDENTS may occur.

By granting permission for your student-athlete to participate in athletic competition, you, the parent or guardian, acknowledge that such risks exist.

Student-Athlete’s Signature __________________________________________ Date ______________

Parent’s / Guardian’s Signature _______________________________________ Date ______________

Certificate of Student Insurance:

It is the responsibility of the parent / guardian to secure insurance coverage prior to participation in athletics. Sections 32220-32224 of Education Code

requires that each member of an athletic team have insurance. I certify that my student is covered by insurance as required and further, said coverage

will be in force for the entire current school year. I understand that the school district has made available an accident insurance program in which my

child may enroll and that the program is optional.

Name of Insurance Company ______________________________________ Policy # ______________

Myers-Stevens Insurance (optional) Date mailed ____________________________________________

Parental Consent and Co-Curricular Agreement:

I hereby give consent for my student to participate in Interscholastic Athletics in the Wm. S. Hart Union High School District. In case of injury to my

daughter/son, you are authorized to have him/her treated. I further understand that in case of injury, the school staff and Associated Student Body is

relieved of all liability from medical or hospital b ills sustained in participation in interscholastic athletic competition. I hereby give my consent for my

daughter/son to compete in sports and go with a representative of the school on any trip(s). I have also read the co-curricular policy regarding requirements

for participation in school activities and agree to abide by the rules and regulations. (See “Notice of Rights, Regulations and Responsibilities”)

Student-Athlete’s Signature __________________________________________ Date ______________

Parent’s / Guardian’s Signature _______________________________________ Date ______________

Canyon High School

Summer Athletics Program

CANYON SPORTS WEB-SITE CONSENT (www.cowboysathletics.org)

For the purpose of giving recognition to student-athletes, roster listings and overall administrative organization, I hereby consent to allow the

Canyon High School Athletic Department to use

______________________________________________________’s name and photograph on the Canyon

(Please Print Student’s Name)

High School Web-Site. This is also to be used in connection with the Athlete of the Month awards, game and banquet photos as well as other links

that show a student’s likeness as associated with his/her name in caption.

Parent’s Signature X_________________________________________________________________

(Date)

Student’s Signature X________________________________________________________________

(Date)

RELEASE FROM TEAM BUS

If parents wish to have their son or daughter released to them after an athletic contest outside

the SCV valley they must complete this form. The parent and students must have face to face contact with the Head Coach of that particular

event and specify that he or she (parent) will be taking full responsibility of his or her student. FOR IN VALLEY (SCV) CONTESTS

THERE WILL ONLY BE ONE WAY BUS DROPS...NO BUS RETURN TO HOME SCHOOL SITE… PARENTS WILL PICK-UP

THEIR STUDENTS FROM CONTEST SITE.

Parent’s Signature X_________________________________________________________________

(Date)

DMV Clearance

All adults, employees, volunteers, or parents must have a DMV Clearance performed by the District Transportation office if they are driving

a district vehicle or using their personal vehicle to carry students other than their own children to District events. Parents who are only driving their

own children do not have to be cleared by DMV. Clearance is valid for the current school year and expire on July 1.

All occupants must wear a seatbelt. Private vehicles must be registered in California. The number of passengers, including the driver, may never

exceed 8 person including the driver. Submit all form to transportation office. Volunteer Driver Application Checklist : 1. Photocopy of valid Driver License.

2. Photocopy of valid Proof of Insurance Card. 3. Complete Volunteer Driver Information Form.4. Complete Participation of District Volunteer

In Field Trip Activity Assumption of Risk and Medicla Treatment Authroization Form.

RETURN THIS FORM TO YOUR COACH

Please turn this athletic emergency / clearance form to your coach the first day of camp.

Students enrolled in more than one camp should give this form to the coach of the first camp.

Canyon High School

Summer Athletics Program

CIF SOUTHERN SECTION CODE OF ETHICS

Athletics is an integral part of the school’s total educational program. All school activities, curricular and extra-curricular, in the classroom and on the playing field,

must be congruent with the school’s stated goals and objectives established for the intellectual, physical, social and moral development of its students. It is within this

context that the following Code of Ethics is presented.

As an athlete, I understand that it is my responsibility to:

1. Place academic achievement as the highest priority.

2. Show respect for teammates, opponents, officials and coaches.

3. Respect the integrity and judgment of game officials.

4. Exhibit fair play, sportsmanship and proper conduct on and off the playing field.

5. Maintain a high level of safety awareness.

6. Refrain from the use of profanity, vulgarity and other offensive language and gestures.

7. Adhere to the established rules and standards of the game to be played.

8. Respect all equipment and use it safely and appropriately.

9. Refrain from the use of alcohol, tobacco, illegal and non-prescriptive drugs, anabolic steroids or any substance to increase physical development or performance

that is not approved by the United States Food and Drug Administration, Surgeon General of the United States or American Medical Association.

10. Know and follow all state, section and school athletic rules and regulations as they pertain to eligibility and sports participation.

11. Win with character, lose with dignity.

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, 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 (Article 523).

By signing below, both the participating student athlete and the parents, 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 recognize that under CIF Bylaw 202, there could be penalties for false or fraudulent information.

We also understand that the (school/school district name) policy regarding the use of illegal drugs will be enforced for any violations of these rules.

Printed Student-Athlete’s Name ______________________________________ Date ______________

Student-Athlete’s Signature __________________________________________ Date ______________

Parent’s / Guardian’s Signature _______________________________________ Date ______________

Canyon High School

Summer Athletics Program

CERTIFICATE OF PHYSICAL EXAMINATION

Name DOB / /

Height Weight Pulse BP /

Please place a “a” as either Normal or Abnormal for all findings below. Please describe in detail all abnormal findings.

	Normal	Abnormal	Comments
Heart
Pulses
Lungs
Neck
Back
Shoulder/Arm
Wrist/Hand
Hip/Thigh
Knee
Leg/Ankle/Foot
Other pertinent medical findings

Additional comments:

_____ _

____________

List any restrictions and duration:

I hereby certify that was examined by me on 200

and found to be physically fit to engage in athletics.

Physician’s Signature Date

Stamp name or attach card of medical office here 6