INTRAMURAL BASKETBALL ELIGIBILITY CHECK-LIST
REQUIRED PAPERWORK FOR REVIEW AND/OR SIGNATURE:

Academic Policies

NSCC Application for Admission

Release of Information

Intramural Questionnaire/ Disclaimer

Intramural Participant Agreement
For more information, please contact:
Program Coordinator
Jaime Radcliff
jaime.radcliff@seattlecolleges.edu
206.934.3745
Wellness Center Director
Carianya Napoli
carianya.napoli@seattlecolleges.edu
206.934.4591
Athletics Fax Machine: 206.934.7787
ACADEMIC POLICIES FOR STUDENT ATHLETES
I.
Basic Premise: Sports and Academics Are Both Important.
A.
Program Goals:
1.
For Everyone To Get To The Next Level: A 4-Year School
a.
b.
Average GPA of 2.0 or higher
Degree Completion
______________________________________________________ Date _________________
Intramural Student Participant Signature
INFORMED ACKNOWLEDGMENTS OF HAZARDS AND RISKS CONNECTED WITH
PARTICIPATION IN INTRAMURAL BASKETBALL
THIS FORM MUST BE SIGNED BY THE STUDENT AND PARENT OR LEGAL
GUARDIAN IF THE STUDENT IS UNDER 18 YEARS OF AGE
PLEASE READ CAREFULLY AND BE SURE YOU UNDERSTAND BEFORE YOU SIGN
WARNING
The purpose of this WARNING is to bring to your attention the existence of potential dangers
associated with athletic participation. There is, however, always the risk of other types of
injuries or the risk of injury or death resulting form other causes not specified here.
This warning also serves to aid you in making an informed decision as to whether you (or your
child or ward) should participate in this athletic activity and, as a condition of such participation,
sign the foregoing ACKNOWLEDGEMENT OF HAZARDS AND RISKS CONNECTED
WITH PARTICIPATION IN BASKETBALL. In addition, its purpose is to make you aware that
as a student-athlete (or as a parent or guardian of a student-athlete), it is your responsibility to
learn about and/or ask coaches, physicians, or other knowledgeable persons about any concerns
that you might have at any time regarding athletic safety and participation in the College’s
basketball program.
Participation in any athletic activity can involve injury of some type to either yourself or fellow
student-athletes. Such injury can include direct physical and possibly crippling injury to one’s
body. There is also the possibility of suffering emotional distress or psychological injury as a
result of witnessing, or actually inflicting injury, to another. The severity of such injury can
range from minor cuts, scrapes, bruises, muscle strains, or bone fractures and dislocations to
catastrophic injury, such as complete paralysis, or even death. Such injury can impair one’s
general physical and mental health and hinder one’s future ability to earn a living, to engage in
other business, social and recreational activities, and generally to enjoy life.
Basketball is a sport involving contact. As in all sports, basketball involves the RISKS OF
SERIOUS INJURY OR DEATH. Because it is a contact sport, basketball involves the potential
risk of serious injury to virtually every part of the human anatomy. Injuries in this sport are
common, and occur to all parts of the body, including the head and nick, shoulders, arms, chest,
hands and fingers, hips, legs, knees, ankles and feet.
These risks of injury in the sport of basketball include the possibility of:

Injury to the neck and spinal column or cord, resulting in complete or partial
paralysis.

Injury to the head, resulting in brain damage.

Injury to the body’s major joints, ligaments, muscles, tendons and other internal
aspects of the musculoskeletal system.

Injury to the body’s nerves, the heart and blood vessels, and other internal or
reproductive organs is also possible. Such injuries may cause temporary
disability or can result in permanent impairment.
Pre-existing medical conditions, including illness, disease, and prior injuries can be aggravated
or cause other injuries while engaged in the sport of basketball. Use of drugs, alcohol or
medications can contribute to injury or illness while participation in athletic activity. Some
injuries may be caused as a result of poor physical condition and overexertion. Such
overexertion can result in injury to muscles, the heart, and to other body parts, resulting in
sprains, strains, cardiac or cardiopulmonary arrest, and other medical conditions. Direct blows to
the head and chest caused by falling or colliding with other players may cause fatalities in
basketball.
Other basketball related injuries can result from:

The use of correct or incorrect playing techniques used in tryouts, practices, drills,
exercises, warm-ups, games, plays, or other similar undertakings.

Injury to the head, or other parts of the body, from contact with other participants,
the playing surface, training equipment, and/or other solid objects in and around
the basketball court.

The improper fit of equipment, defective or worn-out equipment, or from
otherwise wearing and/or failing to use basketball equipment or other protective
gear.

Training room procedures, the use of training equipment, or from administration
of first aid or from failing to follow game, training, safety, or other team rules.

The use of playing techniques taught or from teaching methods employed by the
coaches of this community college.

The use of transportation provided or arranged by the college to and from
basketball games and other related activities.
STUDENT-PARENTAL ACKNOWLEDGEMENT OF HAZARDS AND RISKS
I have read the above WARNING, which is incorporated here by reference, and I understand that
basketball is a sport involving the RISK OF INJURY OR DEATH. I also understand that by
participating (or by permitting my child or ward to participate) in the basketball program at this
community college, I (or my child or ward) am subjecting myself to the possibility of injury or
death as outlined in the WARNING above.
CAUTION
BY SIGNING THIS ACKNOWLEDGMENT OF HAZARDS AND RISKS, I
ACKNOWELDGE THAT I HAVE READ ITS CONTENTS AND WARNING, THAT I
UNDERSTAND ITS CONTENTS AND WARNINGS, AND THAT I AGREE TO ITS TERMS
AND CHOOSE TO PARTICIPATE (OR TO PERMIT MY CHILD OR WARD TO
PARTICIPATE) IN THE INTRAMURAL SPORT OF BASKETBALL AT THIS
COMMUNITY COLLEGE.
Date: __________________, 20______
____________________________________
Signature of Student
Date: __________________, 20______
____________________________________
Signature of Parent or Legal Guardian (if
Student is Under 18 Years of Age)
WITNESS COLLEGE OFFICIAL
On the day ________________ of _________, 20______ I witnessed the execution of the above.
________________________________________________
Signature of School Official
Position
NOTE: If it is not possible for a college official to witness the signature of the parent or guardian
where the student is under the age of 18, a notary shall witness the parent’s or guardian’s
signature to this acknowledgement of hazards and risks.
Assumption of Risks and Release Form: Basketball
NORTH SEATTLE COMMUNITY COLLEGE
INTRAMURAL SPORTS PROGRAM
______________PARTICIPANT RELEASE OF INFORMATION FORM_____________
During the course of a student-athlete’s participation in the athletics program at North Seattle
Community College, it may become necessary for the athletics program staff to have contact
with other agencies and personnel regarding the student-athlete’s progress, personal needs,
support services, test results and/or school records.
I agree to allow the staff at North Seattle Community College athletics program to have contact
with such personnel including, but not limited to: schools; social service agencies; testing
centers; employers; instructors and family members for the purpose of obtaining, providing or
exchanging pertinent information which may be used to assist in supporting and monitoring my
education program. This includes my authorization for North Seattle Community College
athletics program to obtain my grades, course information, GED test scores and other test results
as needed by the program.
I also authorize North Seattle Community College athletics staff to provide Northwest Athletics
Association of Community Colleges (NWAACC), my demographic information including, but
not limited to: name; date of birth; student identification number; last school attended and GPA
status for reporting purposes.
I understand that this information will be kept confidential as defined by North Seattle
Community College students’ right to privacy guidelines. I also understand that if I wish to
withdraw this release of information, it is my responsibility to state so in writing to the North
Seattle Community College athletics program staff/program director.
Date: _________________
Intramural Student Signature:_____________________________________
If participant is a minor:
Parent or Legal Guardian Signature: ________________________________________________
STUDENT INFORMATION
Personal Information/Questionnaire
Intramural Participant Name_____________________________________________
SID #_____________________________
Intramural Sport __________________________
Major_____________________________________
Graduation year_________
Email _____________________________________
Phone Number___________________
Address_________________________________________________________________
Male or Female___
Are you employed? Y/N
Are you a Transfer Student? Y/N
Will you be the 1st college graduate in your family? Y/N
Do you have an academic advisor? Y/N
Circle one or more that apply: Drive Bike Walk Bus to NSCC
NSCC INTRAMURAL PARTICIPANT
TRAVEL AGREEMENT
Attendance at NSCC INTRAMURAL Department sponsored events carries with it the
expectation that Intramural participants will conduct themselves as responsible
individuals during games, team activities, travel, and during their “free time.” Please
review the following agreement. Once reviewed, please sign at the bottom.
While in travel status, I am representing North Seattle Community College, and the Intramural
basketball program of the Seattle Community College District.
As a student-athlete, I will honor the NSCC student code of conduct and the NSCC Intramural
participant agreement; act responsibly while being respectful of school property.
Consumption of alcohol, drugs or disruptive behavior while in travel status with NSCC is against
the student conduct code and will result in disciplinary action.
All students will travel together. Personal cars will not be used unless prior arrangements have
been approved.
I understand that once I receive my food allowance for the trip, I am responsible for managing
the funds. I further understand that if I, for any reason, lose or spend over my food allowance,
that I will be personally responsible for covering my food and beverages for the remainder of the
trip. I will not receive any additional money from the Intramural department or North Seattle
Community College.
I have read and understand this agreement and will abide by the conduct requirements as
outlined in this document.
Signature of Student ______________________________________ Date _________________
Signature of Wellness Director _______________________________Date _________________
Signature of Program Coordinator ____________________________ Date _________________
Alcohol and Drug Policy
Intramural Department:
As a Student/Faculty member of Seattle Community College, you are required to represent the
college in a manner consistent with the SCCD Student Code of Conduct. If alcohol or drug use
is witnessed, you will be immediately suspended from the team.
________________________________________
Alcohol and Drug Policy
Seattle Community College District VI recognizes that illicit drugs and alcohol abuse are major
social problems which affect the health, safety, and security of individuals and organizations.
It is the policy of Seattle Community College District to prohibit the unlawful manufacturing,
distributing, possessing, or use of illicit drugs and abuse of alcohol. This policy applies to all
employees and students of Seattle Community College District VI, while in or on any owned
and/or controlled property of Seattle Community College District VI, or while conducting
college business regardless of location.
Students who violate this policy will be disciplined up to and including expulsion from the
District depending upon the seriousness of the violation. Disciplinary action will be processed by
the office of the Vice President of Student Services. Students may also lose federal funding
and/or grants for their education. Students who need assistance in dealing with drug/alcohol
abuse problems are encouraged to seek help through Student Services. Each campus will
establish a drug-free awareness program for students.
Nothing stated herein shall preclude Seattle Community College District VI from referring
violators of this policy for prosecution as required by law.
WAC 132F-136—6- Prohibited Conduct at College Facilities
I, _____________________________, have read the above and agree to abide by the policy in
its entirety. If I choose to do otherwise, I understand that I risk losing the opportunity to
participate and/or retain a scholarship in the basketball program. Violations of the Student Code
of Conduct may result in additional disciplinary action.
_______________________________________
_____________________
Signature
Date