Downloadable Forms
Click to DOWNLOAD
Expense Authorization / Reimbursement Form
Athletic Clearance – Please click HERE to fill out District required Athletic Clearance forms
—————————————————————————————————-
The website will direct you through the entire process.
• You must print the Athletic Clearance Form.
• You must print one Online Registration Sports Summary Page for each sport of participation.
• Note: If this is the second or third sport, only the Online Registration Sports Summary Page must be submitted.
—————————————————————————————————-
The Physician’s Statement in section 1 of the Athletic Clearance Form must be completed. The Athletic Clearance Form will not be accepted without the following.
• The physician must sign.
• The date that the form is completed must be entered.
• The physician must stamp.
The Insurance Information in section 2 must be completed. All students participating in athletics must have personal health insurance. If the student does not have health insurance, they may purchase it through a company that is used by the district. See Randy Takahashi, the athletic director for information.
The Volunteer Personal Automobile Use in section 3 is voluntary, but completion of this section is strongly recommended as spontaneous opportunities for transport occur. Remember to sign and date.
The Parent Consent in section 4 must be completed. Remember to sign and date.
The Online Registration Sports Summary Page on the second page must be completed. Remember to sign and date.
The Athletic Donation of $260 is not mandatory to complete the Athletic Clearance. The athletic department encourages payment of the donation. Without the support from our athletic department families, we are in real danger of having programs reduced. If a student has paid two athletic clearance donations for the school year, or a family has multiple students, and has paid four athletic clearance donations for the school year, the athletic department thanks you and would not ask for any further donations.
The donation may be paid on the Webstore. If paid by check, the check made payable to Acalanes High School may be submitted at the same time as the Athletic Clearance paperwork.
—————————————————————————————————-
The Athletic Department strongly encourages purchase of a Booster Club membership. This financial support is important because the Booster Club is the sole financial sponsor of the Athletic Trainer’s stipend for Chris Clark as well as all of the supplies for the Athletic Training program. The district does not pay for any of these costs.
—————————————————————————————————-
Athletic Clearances will be collected during residency verification August 4 through August 12. There will also be collection times from August 15 up to the first day of school, including the entirety of Don’s Days. Once school begins, they will be collected in room from the students in room 207 at the following times.
• Monday, Tuesday, Thursday, and Friday from 7:30 to 7:50.
• Monday through Friday at Brunch and Lunch.
—————————————————————————————————-
If you are having difficulty getting the physician to sign the Athletic Clearance Form, you may contact the following medical providers for same day or next day appointments.
Dr. William Workman Walnut Creek Urgent Care
Acalanes HS athletic team physician 112 La Casa Via Way, suite 135
301 Lennon Lane, Suite #100 Walnut Creek, CA 94596
Walnut Creek, CA 94598 Monday through Saturday
Mondays and Thursdays only $150
925-944-0110 925-930-8200
—————————————————————————————————-
For questions or problem solving, contact Randy Takahashi by email at rtakahashi@acalanes.k12.ca.us
