Parent Permission - Oldham County Schools

Oldham County
High School
COLONEL Athletics
MEDICAL, PARENTAL, AND INSURANCE
FORMS (PLEASE PRINT)
NAME OF ATHLETE:________________________
SPORTS PLAYED: __________________________
◊ Student Athlete Information Sheet (Return to Head Coach)
◊ Insurance verification form (Return to Head Coach)
◊ Field Trip Permission and Release Form (Return to Head Coach)
◊ Permission to participate and release form (Return to Head Coach)
◊ OCBE Athletic transportation form (Return to Head Coach)
◊ OCBE Athletic policies (Read and Keep)
◊ Drug Testing Forms (Return to Head Coach)

Student Athlete Information Sheet
School Year: 20__- 20__
DIRECTIONS: PLEASE PRINT: Please enter all date required below.
Last Name:_________________________ First Name: __________________________
Date of Birth: ______________________
Gender: _____________________________
Birth City: _________________________ Birth State: __________________________
Birth County: ______________________
Birth Country: _______________________
Class / Grade as of August of this school year: __________________________________
Height: ___________________________
Weight: _____________________________
Address: ________________________________________________________________
City: _____________________________
Home Phone: ______________________
State ______ Zip ____________________
Guardian Cell phone: __________________
Guardian Name(s): ___________________________
___________________________
Relationship: ____________
Relationship: ____________
Other sports you might be interested in at OCHS:
______________________, ______________________, _________________________

Oldham County High School
1150 N. Hwy 393, Buckner, KY 40010 (502) 222-9461
CONSENT TO PARTICIPATE IN ATHLETIC PROGRAMS
The KENTUCKY HIGH SCHOOL ATHLETIC ASSOCIATION requires each participant in high school athletic
programs to have health insurance coverage with a reputable insurance company. In order to satisfy this
requirement you have the option of selecting the SCHOLASTIC INSURANCE plan offered through the school
insurance program, or to waive the school insurance in favor of your family policy.
If you opt to waive the SCHOLASTIC INSURANCE, you are agreeing that you or your health insurance plan
will be responsible for covering any medical costs or expenses that arise in connection with your child’s
participation in OCHS athletic programs. Neither the Oldham County High School nor the Oldham County
Board of Education is responsible for medical expenses incurred as a result of your child’s participation in
the athletic program.
If you select the SCHOLASTIC INSURANCE coverage you will need to contact the OCHS Office Manager to
arrange to purchase school insurance prior to your child beginning practice in his or her athletic program.
SCHOLASTIC INSURANCE may also be purchased as supplemental insurance.
------------------------------------ Please Complete this Section -----------------------------------
I hereby grant permission for my child, _________________________, to participate in
the following athletic program(s) ____________________________________________
for the 20__ - 20__ school year.
Please complete the following:
____
school.
A. My child will be covered by SCHOLASTIC INSURANCE offered through the
_____ I will purchase this coverage prior to my child’s participation, or
_____ I have already purchased SCHOLASTIC INSURANCE coverage.
____ B. My child will not be covered by SCHOLASTIC INSURANCE as either primary or
supplemental insurance. My child has health insurance coverage through the
_________________________ (insurance company) Plan and I will look solely to this
policy or my personal resources to cover any injuries sustained by my child.
I understand that neither Oldham County High School nor the Oldham County Board of
Education will be responsible for paying any medical or hospital bills not covered by the
SCHOLASTIC INSURANCE policy or other health insurance policies carried by our family.
Parent Signature:__________________________________ Date: _________________

OLDHAM COUNTY BOARD OF EDUCATION
ADMINISTRATIVE REGULATION – 4055.01-F
FIELD TRIP PERMISSION FORM AND RELEASE
Related to Board Policy 4055
The undersigned parent/guardian of ____________________________________ ____/______/______
Student’s Name
Birthdate
hereby grants permission for the above named student to participate in the following field trip; including all
organized activities and transportation:
Date: _________________________________ Fee (if any)_______________________________
Trip Description/Location: _________________________________________________________
Supervising Staff Member: ________________________________________________________
Approximate time of departure _____________________________________________________
Approximate time of return ________________________________________________________
Purpose (state expected learning outcome or recreational) ________________________________
Transportation will be by _ Commercial Bus _ School Bus
Students must have proof of private insurance or student accident insurance to participate in co-curriculars
or extra-curricular activities or field trips away from school.
_______________________________________ _______________________/_____________________
Name of Insurance Carrier Policy Number Group Number
In consideration of the advantages of participation in this field trip, the undersigned agrees that the Board
of Education of Oldham County, Kentucky, its agents and employees, and the driver and/or owner of the
vehicle used for the field trip shall be released and exempt from any liability for damages for bodily injury
or property damage that may occur during the trip, as provided by law.
To Whom It May Concern: We (I), as Parent(s) of ___________________________do hereby authorize
and direct the staff of Oldham County Schools to initiate the procedures deemed necessary by medical
personnel to act in our child’s behalf and agree to “Hold Them Harmless” for any treatment rendered.
Date Signed: ______________________
_________________________________
Signature of Parent/Guardian
Adopted: March 16, 1981
Revised: July 17, 1983
Revised: February 22, 1993
Revised: February 10, 1998
Revised: August 15, 1998
Revised: September 1, 1998
Revised: June 23, 1999
Revised: July 14, 2000
Revised: June 26, 2006

OLDHAM COUNTY BOARD OF EDUCATION
ADMINISTRATIVE REGULATION - 9060-F
PERMISSION TO PARTICIPATE AND RELEASE
Related to Board Policy 9060
The undersigned as parent/guardian of student _______________________________ ___/___/____
(Student’s Name)
(Birthdate)
hereby grant permission for my child to participate in:
(Circle all that apply for the _________________school year:
Baseball Cross Country Golf Swimming Volleyball
Basketball Dance Soccer Tennis Wrestling
Cheerleading Football Softball Track Other
(For sports, attach schedule for competition and practices)
I understand that the activity(ies) described above are potentially dangerous. I understand that there
are inherent risks, including the risk of serious bodily injury or death, associated with participation
in this/these activity(ies) and that all rules and regulations imposed upon the participant by the
coach, supervising staff or Board of Education must be followed strictly in order to reduce any
potential risks or prevent injury. I further understand that participation is not required in any way
and is completely voluntary.
In consideration for the advantages of my/my child’s participation in the activity(ies) described above, I,
for myself, my spouse, my heirs and assigns, hereby release and hold harmless the Oldham County Board
of Education (OCBE), its present and future individual members, officers, agents, employees, directors,
representatives and insurers, from any and all liability, for bodily injury or property damages that may
result from my child’s participation in the activity(ies) described above except as provided by law.
Neither the school nor the OCBE has provisions for payment of medical or hospital bills in case of an
injury to your child. Students must have proof of insurance or student accident insurance to participate in
co-curricular or extra-curricular activities including intra-murals. Participation will be denied until
insurance coverage is verified.
_________________________________________________________
Insurance Company (Indicate Private or Student Accident Insurance
_____________________________
Policy Number
I HAVE READ THE ABOVE INFORMATION, UNDERSTAND IT, AND MY SIGNATURE
INDICATES AGREEMENT.
____________________________________________ _______________ ____________________
(Signature of Parent/Guardian)(Circle One) (Date) (Parent Day Phone #)
____________________________________________ _______________ _____________________
(Signature of Student Required if 18 years or older) (Date) (Parent Evening Phone #)
Other Emergency Contact In Event Parent Cannot Be Reached: _________________________________
Phone __________________________
Adopted: December 19, 1988 Revised: May 6, 1994 Revised: July 14, 2000
Revised: January 19, 1990 Revised: February 12, 1998
Revised: July 15, 1993 Revised: August 15, 1998

OLDHAM COUNTY BOARD OF EDUCATION
ADMINISTRATIVE REGULATION – 8005.001-F
SPORTS & EXTRACURRICULAR ALTERNATIVE TRANSPORTATION CONSENT
Related to Board Policy 8005
Related to 8005-AR; 8005.01-F
______________________________________________________________________________________
The Oldham County Board of Education offers a broad range of sports and extracurricular activities to
students enrolled in middle and high school. This broad range of activities places constraints on the
ability of the district to provide transportation for all these activities at all times. As a result, there are
events, practices and extra-curricular activities that will require the student’s parent to arrange
transportation to and/or from the event or activity. The coach or activity sponsor will provide
information regarding the level of transportation provided by the district.
______________________________________________________________________________________
______
Name of Student: ___________________________________ Date of Birth: ___/____/____
Name of School: ___________________________________ Grade: _____________
Sport/Extracurricular: ____________________________________ Season: _____________
The district will provide transportation to events, games and activities in accordance with 8005-AR. When
the district is unable to provide transportation to events, games and activities, I consent to the following
means of transportation for my child (Check all that apply):
Van/automobile driven by team coach/activity sponsor.
Automobile driven by another parent for whom I have provided written permission to the coach.
Automobile driven by my student.
None. I will be responsible for transporting my child to and from all practices, scrimmages, games and
activities for this sport or extracurricular activity for which the district does not provide transportation.
In consideration of the advantages to my child of participating in this sport or extracurricular activity, to the
extent allowable by law I hereby release and hold harmless the Oldham County Board of Education, its
members, employees, agents, representatives and insurers, and the School and its employees and agents,
from any liability for bodily injury or death resulting from said transportation. I sign this consent and
release individually and on behalf of my student.
__________________________________________ ____________________
Parent/Guardian of the Above Named Student Date
__________________________________________ ____________________
Parent/Guardian of the Above Named Student Date
Adopted: May 26, 200
Revised: August 10, 2006
Revised: March 10, 2008

OLDHAM COUNTY BOARD OF EDUCATION POLICY
ATHLETICS 4015
(Page One of Four)
The Board believes that a comprehensive athletic program is a vital part of the total school program in
Oldham County and it is the intention of the Board to provide the personnel and facilities to establish and
maintain an athletic program as herewith described.
The Board believes:
a. The athletic program is an integral part of the Oldham County Schools' program and should not
be set apart as a separate entity.
b. The athletic program should be conducted in a manner so that the individual welfare of each participant
is the primary concern.
c. The pupil may try out for as many sports as he/she desires without jeopardizing his/her status in other
sports.
d. The athletic program should provide an opportunity for each pupil to develop fully his/her athletic
potentials.
The Board intends that the policy statements included in this guide supplement and not conflict with the
policies of the Kentucky High School Athletic Association (KHSAA). Should such a conflict arise, the
Superintendent will decide which policy shall take precedence.
4015.01 Purpose of Athletic Program
The Oldham County Schools recognize the value of a comprehensive athletic program in interscholastic
and intramural sports that will accomplish the specific objectives as herein listed.
a. Provide an athletic program that will encourage pupils to become active participants.
b. Provide an athletic program that will enable pupils to develop a high level of physical skills
c. Provide an athletic program that will enable the participants to develop and appreciate the
elements of competition.
d. Provide an athletic program that will enable the participants to develop more fully their potential
for leadership and responsibilities.
e. Provide an athletic program that will demonstrate to the participants the value of self-discipline.
f. Provide an athletic program that will require the participants to function as an integral part of a
larger group.
g. Provide a wholesome recreational program for participants and spectators alike.
h. Provide an athletic program that is consistent with the growth and development characteristics of
the participants.
i. Provide an athletic program consistent with the mandates of Title IX.

OLDHAM COUNTY BOARD OF EDUCATION POLICY
ATHLETICS 4015
(Page Two of Four)
4015.02 Composition of Oldham County Athletic Program
Outline of Oldham County interscholastic athletic program.
FALL WINTER SPRING
HS & MS Football HS & MS Basketball HS & MS Baseball
HS & MS Cross Country HS & MS Wrestling HS & MS Track/Field
HS Soccer HS Swimming HS & MS Tennis
HS Volleyball HS & MS Softball
HS & MS Golf *HS Football
*Each football school may conduct ten (10) practice periods of not more than two (2) hours in length and
not more than one practice per day over ten (10) days during the three calendar weeks following the
school’s elimination from post-season play in basketball. All equipment authorized by the football playing
rules may be used during this period. There can be no inter-school competition during this period, and all
participants must be eligible according to all KHSAA eligibility rules.
Intramural sports are offered at both the elementary and middle school level.
4015.03 Provisions
A. General Provisions
1. To be eligible to participate in athletics at any Oldham County School District school, a student
must be enrolled in the Oldham County Schools. Specific eligibility requirements are
determined by each school’s school-based decision-making council and/or the school’s
athletic director and may be found in the school’s Student Handbook.
2. The athletic schedule should be formulated so that all conference, district, or regional
requirements are fulfilled.
3. Games should be scheduled with schools of a comparable size and classification or schools with
reputable athletic programs.
4. Games should be scheduled with schools so that travel distances will be minimal; however, we
recognize the value of a team taking a trip outside of their immediate area.
5. Scheduled games should be postponed or canceled whenever school has been dismissed because
of inclement weather, unless there is a very definite improvement in weather and travel
conditions prior to departure time for visiting team.
6. The Athletic Director is responsible for scheduling competition upon agreement with Principal
and Coach. Schedules must be finalized one month prior to opening of season. There will be
no deviation from submitted schedule. This includes all levels of competition.
7. Personnel for the athletic program shall be provided based on the programs actually operated and
the availability of funds.
8. All participants in interscholastic athletics shall have student accident insurance. The method of
payment for this insurance is left up to the individual schools (Middle and High).
9. All KHSAA regulations must be adhered to strictly.
B. Specific Provisions
1. Football
a. The number of regular season games shall not exceed ten (10) in high school and ten (10)
in middle school.
b. Tournament games are not part of the regular schedule.

OLDHAM COUNTY BOARD OF EDUCATION POLICY
ATHLETICS 4015
(Page Three of Four)
2. Basketball
a. The KHSAA rules regulating the number of regular season games shall prevail.
b. Basketball practice shall not begin until October 15 as stated in KHSAA bylaws.
c. Games scheduled on nights preceding a school day should be with schools where travel
will be minimal.
3. Other Fall Sports
Scheduled contest shall comply with the dates set forth by the KHSAA bylaws for that individual
sport.
4. Other Winter Sports
Scheduled contest shall comply with the dates set forth by the KHSAA bylaws for that individual
sport.
5. Spring Sports and Practice
The maximum number of games or meets to be scheduled shall comply with the KHSAA rules regulating
the number of regular season games.
a. Baseball 30 regular season games
b. Boys Track 15 regular season meets
c. Girls Track 15 regular season meets
d. Fast Pitch Softball 30 regular season games
e. Boys Tennis 20 matches
f. Girls Tennis 20 matches
6. Individual Participation
Individual students may participate in KHSAA regional and our statewide competition. Participation in
such events will be pursuant to KHSAA regulations that govern said participation. The Board requires that
a certified staff member and/or para-professional shall accompany and supervise each individual
participant(s) during competition at regional and/or state levels. Participants shall meet all local
requirements for participation in extra-curricular athletic activities.
4015.04 Definition of Athletic Seasons
The athletic seasons include both practice and regular season games. A practice session is a period of time
that is spent in preparation for the competitive athletic events, and they will normally be comprised of the
following elements: a majority of the participants are present, attendance of participants is expected, the
activities are organized, and the activities are supervised by a coach. Tryouts cannot begin until the
specified date stated in KHSAA bylaws for the individual sport. No tryouts are to take place during an
extended scheduled Board break (fall, winter or spring break).
4015.05 Finance and Care of Equipment
The Board will pay salaries of coaches and provide funds for equipment in emergency situations. The
general rule is that all operating and equipment needs for all interscholastic athletics are to be financed with
gate receipts from the total athletic program, to the extent possible.

OLDHAM COUNTY BOARD OF EDUCATION POLICY
ATHLETICS, Continued 4015
(Page Four of Four)
The school principal is responsible for the financial accounting (as outlined in section 3005.05) and for
developing administrative procedures to assure proper care of equipment.
Adopted Oldham County Board of Education March 7, 1977
Revised Oldham County Board of Education July 13, 1981
Revised Oldham County Board of Education October 7, 1985
Revised Oldham County Board of Education June 19, 1989
Revised Oldham County Board of Education January 14, 1991
Revised Oldham County Board of Education March 9, 1992
Revised Oldham County Board of Education March 17, 1997
Revised Oldham County Board of Education May 11, 1998
Revised Oldham County Board of Education April 17, 2000
Revised Oldham County Board of Education April 28, 2003
Revised Oldham County Board of Education June 28, 2004