Student and Guardian Contact Information

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Student Participation Information

What Fall Sport are you signing up for? *

First Name *

Last Name *

Date of Birth (mo/da/year) *

Age as of September 1, 2024 *

Grade *

Gender *

Street Address *

Town/City *

Zip Code *

Home Phone # *

Student Cell Phone #

Student Email Address

EMAIL PERMISSION OPT-OUT BOX: Sports Booster Clubs may request email lists created by Sports Registration. By checking this box your email address will NOT be shared with a Booster's Club.

Did you attend another High School last year? *

yes

If yes, what school did you attend?

Parent / Guardian Information

Guardian #1 Name *

Relationship to Student *

Check if Applicable

Primary Guardian

Cell Phone # *

Email Address *

EMAIL PERMISSION OPT-OUT BOX: Sports Booster Clubs may request email lists created by Sports Registration. By checking this box your email address will NOT be shared with a Booster's Club.

Guardian #2 Name (if student has only one guardian, skip to alternate emergency contact)

Relationship to Student

Check if Applicable

Primary Guardian

Cell Phone #

Email Address

EMAIL PERMISSION OPT-OUT BOX: Sports Booster Clubs may request email lists created by Sports Registration. By checking this box your email address will NOT be shared with a Booster's Club.

Alternate Emergency Contact *

Relationship to Student *

Cell Phone # *

Home Phone # *

Medical History and Information

Has student ever experienced a traumatic head injury (a blow to the head)? *

yes

If yes, when? Dates (month/year):

Has student ever received medical attention for a head injury? *

yes

If yes, when? Dates (month/year):

If yes, please describe the circumstances:

Was student diagnosed with a concussion? *

yes

If yes, when? Dates (month/year):

Duration of Symptoms (such as headache, difficulty concentrating, fatigue) for most recent concussion:

Please list and explain any Preexisting Medical Conditions and or Allergies (please list none if applicable) *

An Act Relative to Substance Use, Treatment, Education and Prevention

Governor Charlie Baker signed landmark legislation into law to address the deadly opioid epidemic plaguing the Commonwealth. The bill is titled An Act relative to substance use, treatment, education and prevention.

This new law includes multiple provisions including a 7-day limit on every opiate prescription for minors (with certain exceptions), a mandate for a verbal screen for substance use disorders in students and a requirement that information on opiate-use and misuse be disseminated to all students participating in an extracurricular athletic activity prior to their athletic season.

Click on the link below to find information on substance use and misuse, where to get help for your child, resources and a link to the Dept. of Public Health Bureau of Substance Abuse Services.

MDPH Webpage For Parents: Information on Substance Use Disorder

Concussion Education Training Requirement

Student-athletes and parents are required by law to attend complete one annual concussion education training. Student-athletes and parents will be informed about the concussion education program at Cohasset High School including the use of ImPACT Concussion Management Program at the mandatory preseason sports informational meetings.

*IF STUDENT-ATHLETES AND PARENTS DO NOT ATTEND THE PRESEASON MEETING...

The NFHSLearn.com Concussion Course and/or the CDC Heads Up Concussion Training will be offered to all students and parents. Students and parents will need to submit to certificate of course completion to the Athletic Director confirming they completed the course prior to participation in the sport.

To access the free online NFHSLearn.com Concussion Course. Website address http://nfhslearn.com/courses/61037 Please submit certificate of completion.

To access the free online Center For Disease Controls Concussion Course. Website Address http://www.cdc.gov/headsup/youthsports/training/index.html Please submit certificate of completion.

Concussion Training Requirement Please Check One *

Student-Athlete and Parent will attend the Fall Preseason Meeting on September 10th at 6:30pm.

Student-Athlete and Parent have completed the free online NFHSLearn.com Concussion Course. Please submit certificate of completion.

Student-Athlete and Parent have completed the Center For Disease Controls Concussion Course. Please submit certificate of completion.

Head Injury Information for Parents and Students

For further information re: CHS Concussion Education and Management you can visit the CHS Concussion Management page by clicking on this link.

MIAA Rule 56.1 Student Eligibility/School Requirements: Physical Examinations/Medical Coverage/Concussions

It is an MIAA rule that in order to be eligible to participate in Interscholastic Athletics in Massachusetts, you must have a physical exam on record in the CHS Nurses Office. The exam is valid for 13 months from the date it was performed. Unfortunately, the Mass Dept. of Public Health has ruled that virtual physicals are not acceptable to clear a student athlete for athletic participation. Physicals need to be on file in the nurse’s offices, coaches can no longer accept physicals on the first day of tryouts.

Physical examinations must be performed by a duly registered Licensed Physician, Physician’s Assistant or Nurse Practitioner.

Written doctor medical clearance notes do not take the place of an annual physical. MD Clearances will not be accepted.

The MIAA has partnered with Convenient MD Urgent Care and provides sports physicals at their Massachusetts locations. They have locations in Weymouth, Pembroke, and Quincy.

https://convenientmd.com/our-locations/?state=ma&status=open

If you have any questions or medical concerns please contact:

Judy Collins,RN,BSN

School Nurse

Cohasset Middle-High School

Office: 781-383-0853

Fax: 781-383-4168

jcollins@cohassetk12.org

Physical Exam Requirement Please Check One *

A copy of the student's most recent Physical Exam is on file with Nurse Collins in the CMHS Heath Office

A most recent copy of the student's Physical Exam will be sent to Nurse Collins prior to the start of practice.

The student's last Physical Exam is out of date and a new exam will be completed prior to the student being eligible to participate.

Insurance Carrier *

Policy # *

Permission Slip Information

I/we hereby give my son/daughter permission to participate in any of the interscholastic sports that have been selected as listed above.

I/we understand that the Athletic Code outlines the regulations as outlined in the Cohasset High School Student Handbook and the Cohasset High School Athletic Handbook (both available on the school website or a hard copy can be furnished by request) both my son/daughter and I must review and accept in order to participate in interscholastic athletics at Cohasset High School.

I/we certify that the information regarding concussion history above is correct. I/we also understand that I/we must complete an annual concussion education training program that must be attended at a CHS Pre-season Athletic Information night or one of two on-line concussion education courses to be completed prior to participation in athletics.

I/we hereby give my permission for my son/daughter to have an ImPact Test (Immediate Post-concussion Assessment and Cognitive Testing). I understand that my child may need to be tested more than once, depending upon the results of the test, as compared to my child's baseline test, which remains on file at Cohasset High School.

I/we hereby permit my child to receive emergency medical treatment in the event I cannot be reached at the time such treatment is necessary.

I/we have read and understood the information provided by the school that explained the program or event, including the training of participants, the eligibility and safety rules, any equipment to be used, the medical insurance requirements and the school’s emergency medical plan. I/we have had an opportunity to ask questions and have had all of my/our questions adequately answered by school staff.

I/we understand the activities of this program or event, its rules and requirements and its potential risks. I/we accept these conditions and hereby grant permission for my/our child’s participation. I/we hereby forever release the Town of Cohasset, the Town of Cohasset School Department and it officers, employees, agents and volunteers from any and all claims for damages with respect to or in connection with all known and unknown personal injuries incurred by my/our child while participating in the program or event except for damages caused solely by the negligence of the town of Cohasset School Department or its officers, employees, agents or volunteers. I/we hereby agree to indemnify and hold harmless the Town of Cohasset, the Town of Cohasset School Department and its officers, employees, agents and volunteers with respect to any such claims for damages which are not caused solely by the negligence of the Town of Cohasset, the Town of Cohasset School Department or its officers, employees, agents or volunteers.

PARENTAL CONSENT, RELEASE FROM LIABILITY AND INDEMNITY AGREEMENT

We, the undersigned parent/guardian and Student, do hereby consent to Student's participation in voluntary athletic, extracurricular, or co-curricular programs of the Cohasset Public Schools and do forever RELEASE, acquit, discharge, and covenant to hold harmless the Cohasset Public Schools, a municipal corporation of the State of Massachusetts, and its successors, departments, officers, employees, servants, agents, and volunteers ("Releasees"), of and from any and all actions, causes of action, claims, demands, damages, costs, loss of services, expenses and compensation, inclusive of attorney fees, on account of, or in any way growing out of, directly or indirectly, Student's participation in the voluntary athletic, extra-curricular, or co-curricular programs, including but not limited to all known and unknown personal injuries or property damage which well may now or hereafter have as the parent{s) or guardian{s) of said Student, and also all claims or right of action for damages which said Student has or hereafter may acquire, either before or after Student has reached majority, resulting or to result from Student's participation in the Cohasset Public Schools athletic, extra-curricular, or co-curricular programs.

This release includes, but is not limited to, any claim based on allegations of negligence or negligent supervision, or any related claims arising out of the action or non-action of the District's agents, employees, servants, volunteers, or representatives regarding monitoring or supervising the activity of other students, or transfer of them to, on, or in any District facility including but not limited to, play or practice fields and facilities, locker rooms, and vehicles used to transport participants. This release expressly excludes claims based on gross negligence or intentional acts, as defined by M.G.L. c. 258.

Furthermore, we hereby agree to protect the Releasees against any claim for damages, compensation or otherwise on the part of Student growing out of or resulting from injury to said Student in connection with Student's voluntary participation in the Cohasset Public Schools athletic, extra-curricular, or co-curricular programs, and to INDEMNIFY, reimburse or make good to the Releasees any loss or damage or costs, including attorney's fees, the Releasees or their representatives may have to pay if any litigation arises from Student's intentional, grossly negligent or reckless acts or omissions while participating in said athletic, extra-curricular, or co curricular programs.

By signing below, I further certify that Student has had a physical examination and that Student is physically able to participate in in said athletic, extra-curricular, or co-curricular programs.

STUDENT TRANSPORTATION IN PRIVATE VEHICLES

School buses will be used for the transportation of students participating in co-curricular or extracurricular activities. Parents/guardians may be responsible for providing transportation to away contests. Additionally, this winter season parents/guardians may grant permission for their student athlete to be transported to/from away contests in two additional ways:

Parent/Guardian or immediate, household family member may transport them.
Parent/Guardian submits a written request to the Athletic Director and Principal. With permission legally licensed student athletes may transport themselves and any siblings.

Note- A student athlete who has been granted permission for the alternative transportation, may take the bus to some contests while not using it for others.

I HAVE READ AND UNDERSTAND THE INFORMATION LISTED ABOVE AND AGREE TO SIGN THIS FORM ELECTRONICALLY IN THE SPACE PROVIDED BELOW. *

Student

Parent

Student Signature *

Date *

Parent/Guardian Signature *

Date *

Athletic Department Information

Reminder:

The CHS Fall Sports Information Night is mandatory for all fall sport student-athletes and a parent(s).

DATE: Tuesday, September 10th, 6:30pm in the CHS Auditorium.

Twitter
You can also follow daily updates of CHS Athletics on Twitter @CohassetSports

CHS Athletic Department Website:

You can find up-to-date schedules, team information, rules/policies, news, announcements, and contact information at www.cohassetathletics.com

CHS Athletic Department Fall Sports Webpage

Registration Completion

If you did not create an optional login account under the "save and return" tab at the beginning of the form, please save or print this form for your records.

*IMPORTANT NOTE: IF YOU ARE PAYING ONLINE PLEASE SUBMIT OR SAVE AND RETURN THE REGISTRATION FORM BEFORE MAKING A PAYMENT. THE REGISTRATION WILL NOT BE RECEIVED UNLES THE FORM IS SUBMITTED.

Upon submitting this form, you will receive a completion notice. Please save or print the success page for your records.

Steve Rotondi

Athletic Director

Cohasset High School

143 Pond Street, Cohasset, MA 02025

Office Phone: (781) 236-1003

Fax: (781) 383-4168

Email: srotondi@cohassetk12.org

GO BLUE !!!

User Fee Information

Cohasset High School Athletic Department User Fees for 2024-2025

The Cohasset School Committee has established a user fee of:

* $250 for the first sport

* $250 for the second sport

* $150 for the third sport

for a total of $650 per year if a student participates in three different sports.

There is a $900 cap per family.

These funds will be utilized to offset the reductions in the athletic budget.

In order for a student to participate in a sport, the entire user’s fee must be received on or before the first day of competition; no exceptions will be made. This fee, which is non-refundable, does not guarantee that a student will receive equal playing time during each game of his/her selected sport.

Payment should be by check, made payable to: Cohasset High School.

Method of payment *

Bring check to the Fall Sports Preseason Meeting on Tuesday, September 10th.

Pay Online

Reached the individual/family cap

Completed the online fee waiver Completed the online fee waiver

Fall Sports Payment Link

User fee waivers or payment plans

If this fee poses an unusual hardship for any student's family, the parent/guardian should contact either the Principal or Athletic Director so that arrangements may be made for the student(s) to participate.