The Pembroke Public Schools Athletic Department is pleased to have your child as a candidate for one of our interscholastic athletic teams. Participation in sports requires an acceptance of possible risk of injury. Participants can reduce the chance of injury by preparing for their sport with proper conditioning and by obeying all of the safety rules of their sport. It is extremely important that all participants report any injury immediately to their coach and athletic trainer.

All participants should be covered by an adequate program of health insurance. The Pembroke School Department has insurance for athletes who are not covered by insurance and will cover any claims that are not specifically covered by the participant’s insurance.

The student/athlete agrees to adhere to the following:

1. Have an up to date copy of a physical examination (within the last thirteen months) on file with the school nurse prior to participating.

2. Have a signed Release of Claims and Liabilities Form on file with the Athletic Department (available at the end of this electronic packet).

3. Pay a one-time per year user fee. The user fee is due on the date indicated for each season by the Director of Athletics:

Middle School Sports:

• One child one middle school sport $50
• One child unlimited middle school sports $100
• The family cap is $435 which includes high school sports, unless there is a football or hockey player.  Then the family cap is $485.

High School Sports:

• For football, girls ice hockey or boys ice hockey $325 for an individual
• For all other sports $275 for an individual
• The family cap is $435 which includes middle school sports, unless there is a football or hockey player.  Then the family cap is $485.

4. Agree to follow all rules and regulations as set forth in the Pembroke High School Student Handbook and Athletic Code of Conduct:

High School Handbook

5. Agree to follow and adhere to all M.I.A.A. rules and regulations:
https://www.miaa.net/sites/default/files/2024-04/miaa-handbook-23-25.pdf

6. Agree to follow all rules and regulations of the Pembroke Public Schools Athletic Department.

Any student ejected from a game for fighting will be dismissed from the team.

The Pembroke Public Schools Athletic Department is pleased to have your child as a candidate for one of our interscholastic athletic teams. Participation in sports requires an acceptance of possible risk of injury. Participants can reduce the chance of injury by preparing for their sport with proper conditioning and by obeying all of the safety rules of their sport. It is extremely important that all participants report any injury immediately to their coach and athletic trainer.

All participants should be covered by an adequate program of health insurance. The Pembroke School Department has insurance for athletes who are not covered by insurance and will cover any claims that are not specifically covered by the participant’s insurance.

The student/athlete agrees to adhere to the following:

1. Have an up to date copy of a physical examination (within the last thirteen months) on file with the school nurse prior to participating.

2. Have a signed Release of Claims and Liabilities Form on file with the Athletic Department (available at the end of this electronic packet).

3. Pay a one-time per year user fee. The user fee is due on the date indicated for each season by the Director of Athletics:

Middle School Sports:

• One child one middle school sport $50
• One child unlimited middle school sports $100
• The family cap is $435 which includes high school sports, unless there is a football or hockey player.  Then the family cap is $485.

High School Sports:

• For football, girls ice hockey or boys ice hockey $325 for an individual
• For all other sports $275 for an individual
• The family cap is $435 which includes middle school sports, unless there is a football or hockey player.  Then the family cap is $485.

4. Agree to follow all rules and regulations as set forth in the Pembroke High School Student Handbook and Athletic Code of Conduct:

High School Handbook

5. Agree to follow and adhere to all M.I.A.A. rules and regulations: https://www.miaa.net/sites/default/files/2024-04/miaa-handbook-23-25.pdf

6. Agree to follow all rules and regulations of the Pembroke Public Schools Athletic Department.

Any student ejected from a game for fighting will be dismissed from the team.

The Pembroke Public Schools Athletic Department is pleased to have your child as a candidate for one of our interscholastic athletic teams. Participation in sports requires an acceptance of possible risk of injury. Participants can reduce the chance of injury by preparing for their sport with proper conditioning and by obeying all of the safety rules of their sport. It is extremely important that all participants report any injury immediately to their coach and athletic trainer.

All participants should be covered by an adequate program of health insurance. The Pembroke School Department has insurance for athletes who are not covered by insurance and will cover any claims that are not specifically covered by the participant’s insurance.

The student/athlete agrees to adhere to the following:

1. Have an up to date copy of a physical examination (within the last thirteen months) on file with the school nurse prior to participating.

2. Have a signed Release of Claims and Liabilities Form on file with the Athletic Department (available at the end of this electronic packet).

3. Pay a one-time per year user fee. The user fee is due on the date indicated for each season by the Director of Athletics:

Middle School Sports:

• One child one middle school sport $50
• One child unlimited middle school sports $100
• The family cap is $435 which includes high school sports, unless there is a football or hockey player.  Then the family cap is $485.

High School Sports:

• For football, girls ice hockey or boys ice hockey $325 for an individual
• For all other sports $275 for an individual
• The family cap is $435 which includes middle school sports, unless there is a football or hockey player.  Then the family cap is $485.

4. Agree to follow all rules and regulations as set forth in the Pembroke High School Student Handbook and Athletic Code of Conduct:

High School Handbook

5. Agree to follow and adhere to all M.I.A.A. rules and regulations:https://www.miaa.net/sites/default/files/2024-04/miaa-handbook-23-25.pdf

6. Agree to follow all rules and regulations of the Pembroke Public Schools Athletic Department.

Any student ejected from a game for fighting will be dismissed from the team.

This should be completed by the student's parent(s) or legal guardian(s). It must be submitted to the Athletic Director, or official designated by the school, prior to the start of each season a student plans to participate in an extra-curricular athletic activity.

All student-athletes must have a current physical examination on file with the school nurse.  Physical examinations are valid for 13 months from the date of the examination.

It is recommended that physical examinations be performed by a student's own health care provider. If a student is examined at a minute clinic, health express, or urgent care center, then the forms below, including the history form, should be completed by the examining provider and submitted in their entirety to the school nurse. 

Minute Clinic Physical Exam Forms

Physicals can be uploaded below or e-mailed to athletics@pembrokek12.org.

Please review the Extra-Curricular Liability Release.

Please review the State Law Regarding Concussion.

Also please review the NFHS Concussion Course 

Please review the Substance Abuse Information.

As a student-athlete of a Massachusetts Interscholastic Athletic Association member school, I agree to abide by all guidelines regarding the use or exhibition of discriminatory practices.

I PLEDGE TO:

1. Help create and foster a safe environment within the school community, which includes the responsible use of social media.

2. Consistently model respect and tolerance by setting an example of good sportsmanship and positive behavior, including language (body and spoken), gestures, signs, and overtures.

3. Not enable my fellow student-athletes who use abusive language, signs, gestures, or overtures. I will not cover up for them or lie for them if any rules are broken.

4. Hold myself, my fellow student-athletes, and our community responsible and accountable for their actions.

5. Seek information and assistance in dealing with my own or my fellow student athlete’s negative behaviors, problems, or concerns.

6. Be open and honest with my coach and other school personnel when the best interest of myself, my fellow student-athletes, and my school are being jeopardized.

7. Thrive to create a school without hate.

8. Support the Diversity, Equity, and Inclusion, Sportsmanship and Game Officials Committees’ policy/programs within the MIAA, Pembroke High School, and all school functions.

PCMS Athletics User Fee One Child One Sport - $50

PCMS Athletics User Fee One Child Unlimited Sports - $100

PHS Athletics User Fee - Individual football, boys or girls ice hockey player - $325

PHS Athletics User Fee - Individual Player - All other sports - $275

If you plan on submitting more than one Athletic Registration, there is a family cap of $435 unless there is a football or hockey player. The family cap with a football or hockey player is $485

I hereby give my son/daughter permission to participate in the athletic program at Pembroke Public Schools. I agree to follow the rules and regulations set forth in the Pembroke High School Student Handbook and Athletic Code of Conduct, and all M.I.A.A. rules and regulations. I have reviewed and understand the information regarding head injury and concussions. The information I have provided on all forms is accurate. If there are any changes to my child's health history, to parent or emergency contacts, or to any of the information I provided on these forms, I will contact the school promptly to notify them of the changes.