Athletic Clearance Forms

In order for an athlete to participate in athletics at CKM the following forms must be completed:

1. Medical Clearance Form (RSK-F100C)

This Medical Clearance Form must be filled out by the parent/guardian and a licensed physician. Please have doctors sign original document with no attachments.

For walk-in physicals you may contact:
Dr. Sockolov at 916-927-1114
1 Scripps Dr. Suite 200
Monday – Thursday at 4:30pm

2. Agreement for Team Participation Form (RSK-F100A)

This Agreement for Team Participation must be filled out by the parent/guardian.  The parent/guardian must show proof of accidental injury medical insurance. This form is often returned by coaches due to incomplete insurance information. Make sure you fill out both sides of this form. If you currently DO NOT HAVE PRIVATE MEDICAL INSURANCE, you may purchase insurance through the school district. Contact Athletic Director for more information.

3. Concussion and Head Injury Information Sheet (RSK-F100F)

Effective January 1, 2012, a new law (Education Code Section 49475) requires that the student and parent/legal guardian must sign the Concussion and Head Injury Information Sheet before a student may try-out, practice, or compete in any District-sponsored extracurricular athletic program, including interscholastic, intramural, or other sport or recreation programs (including cheer/dance teams and band), but excluding physical education courses for credit.

NOTE: All of the above-mentioned forms are valid from July 1, 2014 to June 30, 2015. Athletes only need to submit the forms once during these dates. However, each new school year the athlete will need to complete new forms. Please make sure you use the correct year when downloading the form.

4. Student Alternate Transportation Form (RSK-F100B)

Due to budget cuts, there are limited funds for transportation. All athletes are required to submit a Student Alternate Transportation Form (RSK-F100B) for each season of sport. This form will cover the athlete for both bus and his/her own transportation to/from the sporting events.

If an athlete is attending a CKM event, the following rules apply no matter where the athlete is being picked up (school or home).

Travel by bus

Athletes are allowed to be signed out only by their parent/guardian. Otherwise, they must board the bus provided by the school.

Travel by car

  1. An athlete can be transported by his/her parent or guardian at any time.
  2. Athletes can drive themselves, but may not transport other athletes at any time (unless legal siblings).
  3. If an athlete is being transported by other parents, the following rules apply:

The parent/guardian must turn in the flollowing documents to the CKM Office Manager for processing (refer to the CKM Volunteer Packet):

  • Registration Form (page 3),
  • Volunteer Interest Form (page 7)
  • copy of a recent TB Test indicating a negative result,
  • completed and cleared Volunteer Background Check Authorization form (BC-1) (page 6), and
  • Verification of Insurance Personal Auto Form (RSK-F106E)  
  • The parent must be cleared by the District as a volunteer to be able to drive other student athletes. For forms and more information on volunteering at CKM, see Volunteer requirements.

5. Athletic Emergency Card

See Athletic Director or coach for a copy of the emergency card.