Preview mode
V 90 90 screen shot 2017 08 23 at 8.56.40 am

St. Anthony Catholic High School 2017/2018 Winter Athletic Registration

  • Review all fields for completion and signatures before submission. Your child is not allowed to participate in any T-CAL events until this registration in completed and submitted. 
  • Athletic physicals must be completed and turned in before student is allowed to try-out and practice with the team. 
Sections
Participant Information

This MEDICAL HISTORY FORM must be completed annually by parent (or guardian) and student in order for the student to participate in athletic activities. These questions are designed to determine if the student has developed any condition which would make it hazardous to participate in an athletic event.

Agreements

For each of the agreements below, please read the terms, check the box to mark your acknowledgement, and type your name to confirm.

PREPARTICIPATION PHYSICAL EVALUATION -- MEDICAL HISTORY

It is understood that even though protective equipment is worn by the athlete, whenever needed, the possibility of an accident still remains. Neither the University Interscholastic League nor the school assumes any responsibility in case an accident occurs.

If, in the judgment of any representative of the school, the above student should need immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given said student by any physician, athletic trainer, nurse or school representative. I do hereby agree to indemnify and save harmless the school and any school or hospital representative from any claim by any person on account of such care and treatment of said student.

If, between this date and the beginning of athletic competition, any illness or injury should occur that may limit this student's participation, I agree to notify the school authorities of such illness or injury.

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Failure to provide truthful responses could subject the student in question to penalties determined by the UIL

Any Yes answer to questions 1, 2, 3, 4, 5, or 6 requires further medical evaluation which may include a physical examination. Written clearance from a physician, physician assistant, chiropractor, or nurse practitioner is required before any participation in UIL practices, games or matches.

THIS FORM MUST BE ON FILE PRIOR TO PARTICIPATION IN ANY PRACTICE, SCRIMMAGE OR CONTEST BEFORE, DURING OR AFTER SCHOOL.


Medical Treatment Acknowledgment

In the event of my absence and if, in the judgement of any representative(s) of the school, the above student needs immediate care and treatment as a result of any injury or sickness, I request, authorize and consent to such care and treatment as may be given to the named student by any physician, trainer, nurse, hospital, or school representative for diagnosis and treatment. I request and authorize physicians, dentists, and staff, duly licensed as Doctors of Medicine or Doctors of Dentistry or other such licensed technicians or nurses, to perform any diagnostic procedures, treatment procedures, operative procedures and x-ray treatment of the above student. The INSURANCE policy listed above will be used to pay for medical care for my child. However I understand and agree to accept responsibility for all payments and agree that the University of the Incarnate Word and St. Anthony Catholic High School bear no responsibility for any medical expenses.

I agree to indemnify and save harmless T-CAL, T-CAL staff, T-CAL Executive Board, the University of the Incarnate Word and St. Anthony Catholic High School, their trustees, officers, employees, volunteers and any school representative from any claim by any person on account of such care and treatment of said student. It is the responsibility of the athlete and parent/guardian to make the Athletic Director and coaches aware of any injury occurring in the participation of the athletic programs. Notification should be made AT THE TIME OF INJURY or as soon as is responsibly practicable, but no later than within forty-eight (48) hours, so proper medical attention, activity adjustment, and documentation is made. St. Anthony Catholic High School is not responsible for payment for any medical expenses for injuries sustained while participating in sports. 

It is the policy of the University of the Incarnate Word and St. Anthony Catholic High School that the Athletic Director and coaches are to be notified of any change of condition that differs from the physical and medical history, and is indicated by means of WRITTEN ORDERS BY THE DOCTOR or medical facility. This notification includes limited practices, required treatment, prescription medication, etc. 

Your signature below gives authorization that is necessary for the school, its athletic director, coaches, associated physicians and school personnel to share information concerning medical diagnosis and treatment of your child.

I fully understand and consent to the MEDICAL TREATMENT ACKNOWLEDGMENT. I understand that all information provided is confidential and that pertinent information may be made available for all coaches, medical personnel, and administration to view.


T-CAL ACKNOWLEDGEMENT OF RULES

Attention School Authorities: This form must be signed yearly by both the student and parent/guardian and be on file at your school before the student may participate in any practice session, scrimmage, or contest. A copy of the student’s medical history and physical examination form signed by a physician or medical history form signed by a parent must also be on file at your school.

Parent or Guardian’s Permit

I hereby give my consent for the above student to compete in University Interscholastic League approved sports, and travel with the coach or other representative of the school on any trips.

It is understood that even though protective equipment is worn by the athlete whenever needed, the possibility of an accident still remains. Neither the Texas Christian Athletic League nor the high school assumes any responsibility in case an accident occurs.

I have read and understand the Texas Christian Athletic League rules are based upon UIL guidelines (with specific exceptions decided by Members). I also have read the rules and regulations from the school and agree that my son/daughter will abide by all rules governing their participation in Athletics.

The undersigned agrees to be responsible for the safe return of all athletic equipment issued by the school to the above named student.

If, in the judgment of any representatives of the school, the above student needs immediate care and treatment as a result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given to said student by any physician, licensed athletic trainer, nurse, hospital, or school representative; and I do hereby agree to indemnify and save harmless the school and any school representative as well as TCAL from any claim by any person whomsoever on account of such care and treatment of said student.

I have been provided the TCAL approved UIL Parent Information Manual regarding health and safety issues including concussions and my responsibilities as a parent/guardian. I understand that failure to provide accurate and truthful information on all forms could subject the student in question to penalties.

The UIL Parent Information Manual is located at http://www.uiltexas.org/files/athletics/manuals/Parent_Manual12.pdf

Your signature below gives authorization that is necessary for the school district, its licensed athletic trainers, coaches, associated physicians and student insurance personnel to share information concerning medical diagnosis and treatment for your student.

Travel Requirements Acknowledgement

The University of the Incarnate Word and/or St. Anthony Catholic High School may provide or will arrange for transportation to all away athletic contests and all team members, managers, and coaches will travel together from the school when transportation is provided by the school. The student athlete will not be permitted to drive a personal vehicle to away contests unless directed by the Athletic Director. After an athletic contest, the student athlete will be permitted to ride home with the parent/legal guardian only if the student-athlete provides at least 24 hours written notice to the coach and only after signing out with the coach. Students, when off-campus and/or in uniform, are subject to all school rules and regulations. I understand that if my student athlete does not conduct him or herself properly , he/she may be (i) sent home at the parent's expense; (ii) suspended from the team; (iii) prohibited from participating in future activities, and/or (iv) subject to other appropriate disciplinary measures. Our signatures indicate our understanding and acceptance of the TRAVEL REQUIREMENTS of the University of the Incarnate Word and St. Anthony Catholic High School.


Waiver of Liability and Hold Harmless Agreement

  1. In consideration of the University of Incarnate Word and or St Anthony Catholic High School providing the opportunity for and permitting the undersigned (Participant) to go on, attend, and/or take part in athletic contests and activities to be held at home and away on during the school year 2017-2018, sponsored by St. Anthony Catholic High School Athletic Department, the Participant and the undersigned Parent or Legal Guardian of the Participant hereby release, remise and forever discharge, indemnify and agree to hold harmless, WAIVE, and COVENANT NOT TO SUE the University of the Incarnate Word and St. Anthony Catholic High School, and their respective trustees, directors, officers, faculty, employees, servants, agents, and assigns, hereafter referred to as (RELEASEES) from any claim, demand or cause of action, whether now in existence or hereafter arising regarding any loss of personal property, injury to the Participant, or related to the death of the Participant, arising out of, resulting from, caused by, occurring during or in any way connected with the athletic contest or activity, including transportation, whether or not such injury, death or damage is caused by or contributed to in whole or in any part by any action or failure to act, negligence, breach of contract, or other misconduct on the part of the RELEASEES, or any other participant in said field trip or activity, any participating parent and/or any one or more of any thereof.
  2. I recognize and acknowledge that certain risks of harm are or may be inherent in the athletic contests and activities and transportation and that the University of the Incarnate Word and St. Anthony Catholic High School cannot control all these risks. I hereby certify by my signature that participant is physically fit and able to participate and I have taken such steps as I deem appropriate to assure myself that participant is fit and capable of such participation. I agree that while participating in the field trip or activity, participant will abide by the guidelines set forth in the and St. Anthony Catholic High School Code of Conduct, Athletic Handbook and St. Anthony Catholic High School Parent-Student Handbook, as applicable. Participant also agrees to adhere to all other applicable rules, regulations, and laws while participating in the field trip or activity.
  3. It is my express intent that this Waiver of Liability and Hold Harmless Agreement shall bind the members of my and participant's family and spouse (if any), and our heirs, assigns and personal representatives and shall be deemed as a RELEASE, WAIVER, DISCHARGE, AND COVENANT NOT TO SUE the RELEASEES. I hereby further agree that this Waiver of Liability and Hold Harmless Agreement shall be constructed in accordance with the laws of the State of Texas. 
  4. I understand that the University of the Incarnate Word and St. Anthony Catholic High School will not be responsible for any medical coasts associated with any injury participant may sustain. I am required by RELEASEES, to maintain adequate health and accident insurance to cover any personal injury to myself which may be sustained while participating in the Activities.
  5. I pledge that I will not consume alcoholic beverages or any controlled substances at any time while participating in the field trip or activity.
  6. IN SIGNING THIS WAIVER OF LIABILITY AND HOLD HARMLESS AGREEMENT, I ACKNOWLEDGE AND REPRESENT THAT I have read it in full, understand it and sign it voluntary as my own free act and deed; no oral representations, statements or inducements, apart from the foregoing written agreement, have been made. I execute this Waiver of Liability and Hold Harmless Agreements for full, adequate, and complete consideration fully intending to be bound by the same.
  7. To Parent/Guardian: I represent and acknowledge by my signature below that I am the Parent or Legal Guardian of the Participant who will be participating in athletic contests and activities offered by St. Anthony Catholic High School.

I HAVE CAREFULLY READ THIS AGREEMENT AND UNDERSTAND THAT IT IS A RELEASE, WAIVER AND HOLD HARMLESS OF LIABILITY OF ALL CLAIMS AND CAUSES OF ACTION FOR ANY INJURY OR DEATH TO PARTICIPANT THAT OCCURS WHILE PARTICIPATING IN THE DESCRIBED FIELD TRIP OR ACTIVITY AND IT OBLIGATES ME TO INDEMNIFY THE PARTIES NAMED FOR ANY LIABILITY FOR INJURY OR DEATH OF ANY PERSON AND DAMAGE TO PROPERTY CAUSED BY PARTICIPANT'S NEGLIGENT OR INTENTIONAL ACT OR OMISSION.

This document will be considered effective on the date signed.


Athletic Code of Conduct

I certify that I have read and acknowledge the school's Travel and Insurance Requirements and agree to abide by the Athletic Code of Conduct. 


Methodist Healthcare - RELEASE AND ACKNOWLEDGEMENT

RELEASE AND ACKNOWLEDGEMENT FOR STUDENTS UNDER EIGHTEEN YEARS OF AGE

On behalf of the above named student, I, the patient's parent, managing conservator, legal guardian, or other person with legal responsibility for the care of the patient acknowledge:

(A) that David R. Schmidt, M.D., Ralph J. Curtis, M.D., Paul S. Saenz, D.O., Timothy S. Palomera, M.D., Marque Allen, DPM, Richard T. Steffen, M.D., Eliot Young, M.D., Hector Lopez, M.D.  and Dan Santa Maria, M.D.  the health care practitioner(s), and any physician assistant, athletic trainer or nurse practitioner assisting each of them are conducting a physical examination or medical screening that is not administered for or in expectation of compensation; 

and

(B) the health care practitioner is immune from civil liability for any act or omission resulting in the death of or injury to the patient from or in connection with the physical examination or medical screening being performed.

RELEASE AND ACKNOWLEDGEMENT FOR STUDENTS OVER EIGHTEEN YEARS OF AGE

I, the above named student, acknowledge:

(A) that David R. Schmidt, M.D., Ralph J. Curtis, M.D., Paul S. Saenz, D.O., Timothy S. Palomera, M.D., Marque Allen, DPM, Richard T. Steffen, M.D., Eliot Young, M.D., Hector Lopez, M.D. and Dan Santa Maria, M.D. the health care practitioner(s), and any physician assistant, athletic trainer or nurse practitioner assisting each of them are conducting a physical examination or medical screening that is not administered for or in expectation of compensation; 

and

(B) the health care practitioner is immune from civil liability for any act or omission resulting in the death of or injury to the patient from or in connection with the physical examination or medical screening being performed.

Please make a selection *
Other registration information
Please upload the most recent copy of your child's physical and copy of insurance card. If not able to upload, please hand deliver to Tony Marciano or Daniel Choate at SACHS. If any questions, please call the school at 210-832-5600.