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Rank One Sport Online Forms


Pre-participation Physical Exam: 
Middlebury Union Middle School requires students participating in athletics to have a pre-participation exam or well child exam performed by a licensed practitioner once every two years. Documentation of exam and medical clearance to participate in athletics is required. Please send forms to the school nurse. If your student athlete is in need of a physical exam please schedule one right away. You are required to provide documentation of physical exam and medical clearance to participate in sports from your student’s physician for our records. 

Please Click Here for a copy of the health clearance form.

Individual Healthcare Plan:
If your student has a health condition that may require urgent or emergent care, we need a copy of his/her Individual Health Care Plan and a doctor’s authorization to provide medication or other care in an emergency. The school nurse can assist you with this plan. A copy of the plan will go to the following individuals: school nurse, school athletic trainer, and your student athlete’s head coach or club advisor. Your student athlete is required to bring any medications they need to all team/group activities including meetings, practices, events, and competitions. These medications might include but are not limited to: asthma inhaler, Epi-pen, and diabetes management supplies. Your cooperation in this matter is critical to your student’s safety. Please contact us with any questions or concerns. 

Completed Forms:
The following forms must be completed prior to your students participation in MUMS athletics/activities.

1. Student Emergency Information
2. Concussion Information
3. Athletics/Activities Participation Contract