MOUNT SAINT DOMINIC ACADEMY
ATHLETIC
PARTICIPATION FORM
Parent/Guardian Name_________________________________________Phone #____________________
Friend/Relative (in case of emergency)____________________________Phone #____________________
I HEREBY REQUEST THE PRIVILEGE OF TRYING OUT FOR AN ATHLETIC TEAM AT MOUNT SAINT DOMINIC ACADEMY. AS A MEMBER OF THIS INTERSCHOLASTIC TEAM, I AGREE TO THE FOLLOWING CONDITIONS FOR PARTICIPATION:
1. I understand that my academic commitments have the highest priority and
I will not be permitted to participate in interscholastic athletics if I do not
comply with the credit requirements established by the NJSIAA and MSDA.
2. I will not use alcohol or other illegal drugs in any form.
3. I will not smoke or use tobacco in any form.
4. I will follow the training rules and practice schedules that are established by the coach.
5. I have read the Mount Saint Dominic Academy student handbook/athletic department policies manual, parent /coach communication pamphlet and will adhere to all listed policies.
6. I will safeguard and properly care for all equipment issued to me. I understand that I will be financially responsible for any loss or damage to equipment.
7. I will not act in any way, which may cause harm or insult (including hazing), to students, teammates, coaches and opposing players in anyway throughout the school year.
8. I realize that if I am not in school at the official start of the school day I forfeit my eligibility to participate in practice/game on that particular school day.
I UNDERSTAND THAT FAILURE TO COMPLY WITH ANY OF THESE CONDITIONS MAY RESULT IN DISCIPLINARY ACTION, INCLUDING EXCLUSION FROM THE TEAM.
Student’s Signature _________________________________________________________
Parent’s Signature _________________________________________________________
Athletic Director’s
Signature _________________________________________________________
Date _________________________________________________________