Registration Online Registration Step 1 of 3 33% Student Name First Last Level7th8thFreshmanJVVarsityMaleFemaleSport*BaseballBoys BasketballBoys Cross CountryBoys GolfBoys SkiingBoys SoccerBoys SwimmingBoys TennisBoys TrackBordercrossBowlingCompetitive CheerEquestrianFootballHockeyGirls BasketballGirls Cross CountryGirls Field HockeyGirls GolfGirls SkiingGirls SoccerGirls SwimmingGirls TennisGirls TrackPom PonSideline CheerSoftballVolleyballWrestlingMS Boys BasketballMS Boys Cross CountryMS Boys Swim & DiveMS Competitive CheerMS FootballMS Girls BasketballMS Girls Cross CountryMS Girls Swim & DiveMS PomsMS Track & FieldMS VolleyballMS WrestlingAddress Street Address Address Line 2 City AlabamaAlaskaArizonaArkansasCaliforniaColoradoConnecticutDelawareDistrict of ColumbiaFloridaGeorgiaHawaiiIdahoIllinoisIndianaIowaKansasKentuckyLouisianaMaineMarylandMassachusettsMichiganMinnesotaMississippiMissouriMontanaNebraskaNevadaNew HampshireNew JerseyNew MexicoNew YorkNorth CarolinaNorth DakotaOhioOklahomaOregonPennsylvaniaRhode IslandSouth CarolinaSouth DakotaTennesseeTexasUtahVermontVirginiaWashingtonWest VirginiaWisconsinWyomingArmed Forces AmericasArmed Forces EuropeArmed Forces Pacific State ZIP Code Phone My initials and signature below indicate that I have received, reviewed and acknowledge the following items related to the Pinckney Community Schools Athletic Participation Program.I have reviewed the Pinckney Community Schools Pay to Participate Athletic Program and understand that the fee I am paying does not guarantee playing time, control over any conditions of the team, and is NOT refundable except as indicated in the policy. If a refund is approved, I am aware that only the $10.00 registration fee will not be refunded. I also understand that paying the fee does not alter Pinckney Board of Education Student Policies, Michigan High School Athletic Association regulations, the Pinckney School District’s Athletic Code, and/or individual team rules. I understand that Pinckney Community Schools does not carry insurance coverage for students and I am responsible for any medical bills my student may incur. I understand optional insurance is available through First Agency Life Insurance Company, information available in the Athletic office.Parent InitialsDo you wish to purchase accident insurance offered by First Agency Life Insurance Co.?YesNoI do not wish to purchase accident insurance offered by First Agency Life Insurance Co.Parent InitialsInsurance Co. NamePolicy NumberI have received and read the copy of the Athletic Code of Conduct covering participation in athletic programs offered by Pinckney Community Schools. I understand the guidelines and I accept my personal responsibility for following all rules contained therein. I understand this code applies to my entire athletic career as a Pinckney schools athlete.Student-Athlete InitialsCONCUSSION AWARENESS EDUCATIONAL MATERIAL ACKNOWLEDGEMENT* By my name and signature below, I acknowledge in accordance with Public Acts 342 & 343 of 2012 that I have received and reviewed the Concussion Fact Sheet for Parents and Students. If you have not read it, the Concussion Fact Sheet can be found here.Parent/Guardian SignatureStudent Signature Emergency Medical InformationFather/Guardian NameFather/Guardian Phone #RelationshipMother/ GuardianMother/Guardian PhoneRelationshipFamily DoctorDoctor Phone #Health InsurancePolicy #In case the athlete becomes ill or injured during a practice or sporting event, the following emergency contact will be called in the following order:NamePhone NumberRelationship NamePhone NumberRelationship NamePhone NumberRelationship The team personnel may administer first aid until our family doctor can be contacted?YesNoWe give our consent for the team physician, certified athletic trainer and/or coaches to use their judgment in securing medical aid and ambulance service if I (we) cannot be contacted immediately.YesNoWe give our consent for the hospital, their agents and/or licensed physician to administer emergency medical treatment as they deem necessary.YesNoOur son/daughter has our permission to practice and compete in the Pinckney Community Schools Interscholastic Athletic Program. We acknowledge the potential for injury during athletic participation. Although serious injuries are not common in supervised school athletic programs, it is impossible to eliminate the risk. Participants have the responsibility to help reduce the chance of injury. Players must obey all safety rules and report all physical problems to their coaches. In case of accident or injury, we are financially responsible for items such as ambulance service, doctor’s fees, hospital fees, etc. We have read, understand and discussed with our son/daughter the regulations and rules of the Pinckney Community Schools Athletic Code of Conduct.Please make us aware of any conditions that your child has by listing any medications or useful information.AsthmaDiabetesHeart ConditionSeizureCriticle AllergiesOther Conditions or ProblemsParent/Guardian SignatureAdditional InformationPay To Participate Information- Special ConditionsInsurance Information When you click submit below you will be directed to a website where you can pay your athletic participation fees. Checks can also be sent in to the Athletics Office at Pinckney HIgh School.