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Medical Authorization Form

indicates a required answer

1. *

Parent(s) or Guardian Names:  Ex. John and Jane Smith or John Doe and Jane Smith 
2. *

Phone Number: Please include the best number to reach you if we have any questions.
3. *

City: Sterling, Dixon, Rock Falls, Etc.
4. *

Are both parents Christians? Briefly share your testimonies.
5. *

Does your family attend church regularly?
Yes No
6. *

What church does your family attend?
7. *

RRU STATEMENT OF FAITH

Mission Statement: The mission of RRU is to help students excel in athletics while growing in Biblically ordered lives in relation to faith, family, and friendships.

Four Core Values:

  1. Biblically ordered lives that honor Christ above all things.
  2. Sportsmanship over superiority.
  3. Supporting families.
  4. Assuming the best in one another.

Statement of Faith:

The Nicene Creed We believe in one God, the Father almighty, maker of heaven and earth, of all things visible and invisible. And in one Lord Jesus Christ, the only Son of God, begotten from the Father before all ages, God from God, Light from Light, true God from true God, begotten, not made; of the same essence as the Father. Through him all things were made. For us and for our salvation he came down from heaven; he became incarnate by the Holy Spirit and the virgin Mary, and was made human. He was crucified for us under Pontius Pilate the suffered and was buried. The third day he rose again, according to the Scriptures. He ascended to heaven and is seated at the right hand of the Father. He will come again with glory to judge the living and the dead. His kingdom will never end. And we believe in the Holy Spirit, the Lord, the giver of life. He proceeds from the Father and the Son, and with the Father and the Son is worshiped and glorified. He spoke through the prophets. We believe in one holy catholic and apostolic church.  We look forward to the resurrection of the dead, and to life in the world to come. Amen.

Statement on Marriage and Sexuality Regarding marriage and sexuality:

RRU believes that the term “marriage” has only one meaning and that meaning is marriage sanctioned by God which joins one biological man and one biological woman in a single, exclusive union, as delineated in Scripture (Genesis 2:18-25; Matthew 19: 4-6). RRU believes that God intends sexual intimacy to only occur between a man and a woman who are married to each other. RRU believes that any form of sexual immorality, such as adultery, fornication, homosexuality, bisexual conduct, bestiality, incest, pornography or any attempt to change one's sex, or disagreement with one's biological sex, is sinful and offensive to God (Romans 1: 24 – 2:2). RRU believes that in order to preserve the function and integrity of the organization as a group of members of various local Bodies of Christ, and to provide a biblical role model to the community, it is imperative that all persons employed by the organization in any capacity, or who serve as volunteers, should abide by and agree to this doctrinal statement on marriage and sexuality and conduct themselves accordingly. This is not to discriminate against an individual based upon his or her sexual orientation or marital status, but rather this is a statute of RRU to obey God in religious freedom so as to abide by such doctrinal beliefs. Although opposition to comply with the practice of these doctrinal beliefs of marriage and sexuality is to sin against God, RRU believes that God offers redemption and restoration to all who confess and forsake their sin, seeking His mercy and forgiveness through Jesus Christ.

Do you agree with the RRU Statement of Faith?
Yes No
8. *

ATHLETE INFORMATION

Have your older children (grades 7-12) come to faith in Christ? 
9. *

How well do your athletes receive instruction? How do they respond to authority and correction?
10. *

Have any of your athletes ever faced, or are currently facing, suspension or expulsion from a public or private school?
Yes No
11. 

If you answered yes to the previous question, please feel free to explain?
12. *

ATHELETE MEDICAL INFORMATION

  1. The athlete(s) is/are not currently under medical care for any condition that would limit their ability to safely and fully participate in sports, events, and activities with Rock River United.
  2. Members recognize the possibility of physical injury associated with Rock River United (RRU) activities and, release, discharge and/or otherwise indemnify RRU, its affiliated organizations and sponsors, their employees and associated personnel, including the owners of fields and facilities utilized for the programs, against any claim by or on behalf of the registrant’s participation in the programs.
  3. An athlete shall participate based on the biological gender noted on the athletes original legible, legal, government-issued Birth Certificate.

I affirm that I have read, understood, and accept the above statements.
Yes No
13. *

MEDIA RELEASE FORM

Members grant RRU permission to publish names and images on the RRU website, in advertisements, and in other social media or publications. RRU may also submit game information to news outlets or organizations that track athletes’ achievements.

Do you give permission?
Yes No
14. *

RRU ATHLETE INTEGRITY COVENANT

I do hereby give my word that I will come to all RRU activities, practices, and games with my heart and mind prepared to honor Christ in word, thought, and action. I will come with a teachable spirit. I will be attentive and respectful of all coaches, teammates, opponents, referees, and fans.

I agree to conduct myself at all times in a manner that glorifies God and brings honor to His name.

I agree that if I fall short of keeping this commitment, I will receive correction with humility, turn from my error, and prayerfully seek the Lord’s forgiveness and help to regain my commitment.

Do the athletes in your family agree to the Integrity Covenant?
Yes No
15. *

RRU CODE OF CONDUCT

Each parent, guardian, and athlete pledges to be responsible for his words and actions while attending, coaching, officiating, or participating in any RRU athletic event and shall conform his behavior to the following code of conduct:

  1. I will treat any coach, parent, spectator, player, official, or any other attendee with respect regardless of race, creed, color, national origin, religion, sex, or ability.
  2. I will not engage in unsportsmanlike conduct with any coach, parent, spectator, player, official, or any other attendee.
  3. I will not engage in any behavior which would endanger the health, safety, or well-being of any coach, parent, spectator, player, official, or any other attendee.
  4. I will not use drugs and/or alcohol at any time while participating on a RRU Sport’s team. I will not attend, coach, officiate, or participate in an athletic event while under the influence of drugs and/or alcohol. If this occurs, the consequence is immediate dismissal from the team.
  5. I will not use tobacco (including smokeless types) and/or vape while at any athletic event. If this happens, there will be a verbal warning (first offense), facilitate a formal hearing (second offense), a final hearing, and a decision (third/final offense).
  6. I will not engage in the use of profanity.
  7. I will not engage in verbal or physical threats or abuse aimed at any coach, parent, spectator, player, official, or any other attendee.
  8. I will not engage in various online group chats that bully, disparage someone’s character, or threaten a coach, parent, player, official, or any other attendee.
  9. I will not initiate a fight or scuffle with any coach, parent, spectator, player, official, or any other attendee.
  10. I will not argue with officials or go through the motions indicating dislike or disdain for a decision.
  11. I will not make any degrading remarks to or about any official, coach, athlete, or school/team.
  12. I will not detain or attempt to stop an official following the contest to request a ruling or explanation of actions taken by the official. I will not follow or “chase” an official after the contest is over.
  13. I will not leave the bleachers or stands and enter the playing area to protest, object, criticize, or check on a player’s injury unless called by a coach or official.
  14. Players will dress appropriately and modestly for their sport and all RRU functions.
    •  All undergarments are to be concealed and measures are to be taken to ensure undergarments do not show through clothing.
    • White undergarments are to be worn under white or light-colored clothing, and spandex or an undershirt should be worn if necessary.
    • Tops and bottoms should be loose fitting, and midriff should be covered with arms raised.
    • Shorts should not be rolled in a way that outlines the front or back of the undergarment area, and the hem of shorts should not be tucked up into the underwear or spandex.
    • Shorts must completely cover the behind when bending over and should have at least a 5” inseam.
    • Necklines must not be revealing or loose fitting.
    • Areas of dress not mentioned or defined in the above statements including modesty and tastefulness, will be left to Board members for interpretation and enforcement.
  15. I will honor and show respect to our country and flag by standing while the National Anthem is being played at all RRU sports events.
  16. I will adheere  to the RRU standards and character expectations at all practices, games, and activities.
  17. I will not solicit or promote any alternative lifestyles or gender dysphoria by displaying identifying symbols or phrases on personal clothing, bags, or equipment, at any RRU practices, games or events.
  18. I will address all other RRU participants according to their biological sex/gender and will not be forced to use "preferred gender" pronouns.

To encourage the reflection of Biblical standards, values, and character at Rock River United, all members are expected to become familiar with and abide by the standards outlined in this policy. 

Will you and your family honor these standards?
Yes No
16. *

If you or your athlete were to disagree with the RRU Code of Conduct, how would you approach resolving that disagreement?
17. *

DISCIPLINE PLAN

Each member by agreeing to the terms of membership are also agreeing to obey the Code of Conduct for the duration of his time as a player, parent, coach, or administrator with Rock River United.

Any member who is consistently neglectful of his or her agreement to the Rock River United Statement of Faith and Code of Conduct, will be given a verbal warning on the first offence. After a verbal warning has been given, members in violation will receive a written warning and be asked to schedule a meeting with the board. Rock River United reserves the right to suspend participation of any member (player and/or his/her family members) at any point in the disciplinary process if it is deemed that the presence of said person(s) is disruptive or could otherwise cause disunity in the operation of the collective. If a third warning is needed, an immediate suspension will be implemented until the event can be reviewed by the board. Membership may be terminated at the recommendation of the board.

Do you understand the RRU Discipline plan?
Yes No
18. *

LEADERSHIP STANDARDS

  1. Members recognize that the RRU Leadership adheres to the RRU Statements of Faith and that these beliefs will be emphasized during practices and games.
  2. Members acknowledge that while all coaches must sign the statement of faith, RRU itself is not responsible for the conduct of each coach.
  3. Members understand that RRU leadership will not conform to alternative lifestyle beliefs or adjust the way training is conducted in order to appease alternative lifestyles and beliefs that may not align with the Statement of Faith.
  4. RRU leadership (directors, coaches, managers) will only use pronouns for a player or parent in/ accordance with their biological sex/gender at birth.

I acknowledge RRUs Leadership Standards.
Yes No
19. *

RRU MEMBERSHIP FEE

Rock River United Annual Membership Fees will be due by August 1st of each year or within two weeks of the approval of your approved application. 

  • 1 st Athlete = $250
  • 2nd Athlete = $200
  • 3rd Athlete = $150,
  • Household Cap of $600

Monthly ETF withdrawals are available if you would like to make arrangements with the Treasurer: 1st Athlete = $26/month, 2nd Athlete = $22/month, 3rd Athlete = $18/month, Cap $66/month *

RRU SPORTS FEES

Sports fees will also be do for each athlete participating in each sport. The sports fees are estimated at $75 per athlete per sport and must be paid in full by the first practice. Trap Shooting may have additional fees.

Do you agree to pay applicable fees associated with your membership?
Yes No
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