Nordonia Hills Middle School Athletic Department
Mrs. Shyla Urban
Middle School Athletic Director
(330)908-6614
THIS PAGE MUST BE COMPLETELY FILLED OUT AND RETURNED WITH A CURRENT PHYSICAL AND EMA BY OCTOBER 23rdTO MRS. RIEDTHALER IN ROOM A132.
A $42.50 participation fee will be charged by the Nordonia Hills Board of Education for anyone participating in athletics.
These fees are non-refundable if an athlete quits, is injured, or becomes academically ineligible during the season. This fee does not guarantee playing time on any team. Fees are due prior to the first game.

Mandatory tryout dates/times for boys'basketball teams are October 26th - October 30th.
7th Gr Basketball tryouts are 3:00-5:00
8th Gr Basketball tryouts are 4:30-6:30

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As a member of a Nordonia Middle School Athletic Team, you will be issued a uniform and/or equipment. You
are responsible for the upkeep of this uniform. The uniform/equipment will be turned in at the end of the
season. You are responsible for the loss or damage of any part of this uniform. At the end of the season, the coach and athletic director will determine if any costs due to loss, damage, or abnormal wear and tear are to be assessed.

Student Name (PRINT)________________________________________

Parent/Guardian Signature_______________________________________

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ACKNOWLEDGMENT OF WARNING BY PARENTS/STUDENT
We/I, the parent(s) of _______________________ (Name of athlete) do hereby acknowledge that we/I have been fully advised, cautioned and warned by the administration and coaching staff of Nordonia Hills City Schools that our/my child named above may suffer injury, including but not limited to sprains, fractures, brain damage, paralysis or even death, by participation in the sport of : Notwithstanding such warnings and with full knowledge and understanding of the risk of serious injury to our/my child named above which may result, we/I give our consent to participate in athletics.

_____________________(Name of Athlete)

_______________________(Parent/Guardian)

ATHLETIC DEPARTMENT INSURANCE WAIVER
We the undersigned, parent(s)/guardian(s) of ________________________ do hereby release the Nordonia Athletic department from any and all financial responsibilities as a result of any and all injuries incurred by our son/daughter as a direct result of his/her participation in pre-season conditioning programs and interscholastic athletics. We certify that such injuries which might be sustained by our son/daughter as a result of participation in pre-season conditioning programs and interscholastic athletics are covered by our family insurance. For those parents/guardians who want excess coverage, the Nordonia Board of Education encourages you to enroll your student in an insurance program.

________________________(Parent/Guardian)

______________________(Date)