Swimming All-Star Acceptance | Mississippi Coaches Association: Online Forms

PLAYER ACCEPTANCE

Dear 2025 Swimming All-Star,

Because of your commitment and dedication to excellence in athletics, you have been chosen to play in the 2026 All-Star Swim Meet. This special honor is extended to only the top 8 finalists in your event at the Swimming State Championship. Congratulations go to you for receiving this recognition. The following information about this year's game may be helpful to you in making your decision to accept this invitation:

The meet will be held at the Tupelo Aquatic Center on Saturday, November 15, 2025. This event will be a timed final.

Players will report at 10:30 a.m. on the date of the All-Star Meet

Secondary insurance will be provided.

As stated in the MAC guidelines, female players cannot participate if pregnant.

The following forms should have been completed, signed, and electronically submitted.

1. Agreement to Play

2. Consent to Medical Treatment and Insurance Coverage Questionnaire

3 Player General Release

4. Statement of Understanding and Notice of Insurance Coverage

5. Your $50 registration fee can be submitted online through our website.

Due date for all electronically submitted formsto be received in the M.A.C. office is Friday, November 7, 2025. If youhaveanyquestions,please contactus. Please let us know immediately if you find that you will not be able to participate.

I look forward to meeting all of you and working with you to make this game a memorable event for all - players, coaches and fans.

Player Name*

First Last

Player Email*

Birth Date*

Age*

Cell Phone*

Home Phone*

Complete Home Mailing Address*

Street Address City State ZIP Code

High School*

High School Coach*

First Last

School Mascot*

Please Select One (Athlete):*

I accept the invitation to play in the 2025 All-Star Swim Meet directed by the Mississippi Association of Coaches, and agree to:

Follow all the rules and regulations of the host college and the Mississippi Association of Coaches;

Notify the Association immediately if circumstances change affecting my decision or ability to play, so that an alternate player can have the chance to play and receive full benefits and honors;

By accepting this invitation I pledge my full support to my team and coaches and agree to accept all the responsibilities which go along with the honor. These responsibilities include meeting all dead- lines, supplying requested information, and reporting on time.

Consent to being contacted by Vertical Raise regarding the All-Star Fundraiser
I will not be able to participate in the 2025 All-Star Swim Meet.
(If you will not be able to participate, please notify the MAC office as soon as possible by phone 601-924-3020 or fax 601-924-3050, or email sangelo@mscoaches.com)

Grade*

Class:*

Gender*

Are you physically able to participate in practice and/or the All-Star Game?*

Have you had an injury since your season began?*

Please explain your injury

CONSENT TO MEDICAL TREATMENT

I am the:*

Mother or Guardian Name*

First Last

Mother or Guardian Email*

Father or Guardian Name*

First Last

Father or Guardian Email*

Complete Home Mailing Address*

Street Address City State ZIP Code

Family Physician*

First Last

Physician Home Phone*

Physician Office Phone*

Part I:*

I/We am/ are the parent(s) of the athletic listed above and state that she has no guardian or conservator appointed by law.

Part I:*

I/We am/are the guardian/conservator of as appointed by law.

Part II:*

I/We in the same capacity as indicated in Part I authorize the Mississippi Association of Coaches to take whatever medical steps are deemed necessary in case of injury and/or illness (including giving authorization to duly qualified medical personnel to administer such medical or surgical treatment to include anesthetics and/or drugs as the duly qualified medical personnel deem necessary in the diagnosis and treatment) of the athlete mentioned above during her participation in the 2025 All- Star Swim Meet November 15, 2025. Treatment of any such injury and/or illness shall begin immediately upon its discovery.

Part III

Insurance Coverage*

The Above named participant is covered by hospitalization insurance.
The Above named participant is not covered by hospitalization insurance.

Policy #*

Name of Insurance Company*

Address of Insurance Company*

Street Address City State ZIP Code

If Group Policy, give Employer

Group #

Does your son/daughter have any Unusual Health Conditions:*

Select all that apply:

Diabetes
Heart Condition
Convulsive Seizures
Alergies
Other
None

"Other' Please list*

Please list Allergies*

PLAYER GENERAL RELEASE

We, the undersigned parent(s) or legal guardian(s) of the player listed above (hereinafter “Player”), a member of the 2025 All-Star Swim Team, for in the consideration of our son/daughter participating in such tournament and in further consideration of the fact that the Mississippi Association of Coaches will house and feed my son/daughter on November 15 2025 do hereby release the Mississippi Association of Coaches, its officers, directors, members and any other agents or representatives (hereinafter “Releasees”) and hereby hold harmless the Releasees against any and all claims, causes of action, demands, costs, expenses, or any other potential actions asserted arising out of or in any way related to or connected with the participation of our son/daughter in the 2025 All-Star Swim Team. We, the undersigned, release the Releasees from any and all claims that may result either from the participation in practices leading up to the 2025 All-Star Swim Team or participation in the tournament. Moreover, we do hereby grant permission to the Mississippi Association of Coaches, the Host school and its staff (all also referred to herein as “Releasees”) to transport and entertain the above named player during the All-Star activities on November 15, 2025, at the close of the All-Star activities at Tupelo Aquatic Center in Tupelo, MS. We, the undersigned, release the above named parties, their agents, employees and other related persons, including all other Releasees, from any and all claims which may result from the travel and entertainment of the above named player.

We also agree that the released parties shall not be responsible for any illness, disease, injury or other occurrence suffered by the player associated with his/her travel, entertainment, participation in practice or in the game, and furthermore agree that there shall be no liability to the Releasees herein for any of the above noted acts.

By these presents and in consideration above enumerated, we further covenant and agree that we shall forever refrain from instituting any action, pressing, collecting or in any way aiding or proceeding upon any and all claims, causes of action, suits and proceedings of any kind at law or in equity which our son/daughter or the undersigned ever has, or may have, against any of the Releasees herein arising out of the aforesaid activities, and more particularly participation in practices and the game relating to the 2025 All-Star Swim Meet, or any other activity relating thereto.

Parent Attestation*

WE ACKNOWLEDGE THAT WE HAVE CAREFULLY READ THE FOREGOING RELEASE AND KNOW THE CONTENTS THEREOF AND WE SIGN THE ABOVE AND FOREGOING OF OUR OWN FREE ACT.

STATEMENT OF UNDERSTANDING AND NOTICE OF INSURANCE COVERAGE

I, the undersigned parent(s) and/or guardian(s) of the athlete listed above, a participant in the2025 All-Star Swim Meet, do understand that the insurance coverage provided for all the participants in this game is known as secondary coverage. This specifically means that my personal insurance company’s policy is the primary coverage for my son/daughter and will be considered primary in the event my son/daughter suffers an accidental injury requiring medical attention, evaluation and/or treatment during any All-Star Activities November 15, 2025.

I further understand that the Mississippi Association of Coaches does provide insurance coverage to my son/daughter, but such coverage is secondary, specifically meaning that such coverage only becomes applicable after my coverage, if any, has first been utilized to cover the expenses and fees for such medical treatment. Moreover, I have been informed that the coverage provided by the Mississippi Association of Coaches may have certain deductions, exclusions and upper limits so as not to provide full coverage to my son/daughter even if the insurance is utilized after exhausting my personal coverage, if any.

I further understand that the Mississippi Association of Coaches provides such coverage for the benefit of the participants in the 2025 All-Star Swim Meet and their parents, and such insurance coverage possibly may not cover all bills, expenses and other costs incurred by the participants while participating in the 2025 All-Star Swim Meet at the Tupelo Aquatic Center in Tupelo, Mississippi. Toward that end, I have been placed on notice by the Mississippi Association of Coaches and its representatives that if additional insurance coverage is needed for my son/daughter, I should provide such insurance at my own expense. I hereby state that the information provided on the Medical Consent form is the correct name, address and policy number of the present health, accident and hospitalization insurance providing coverage for my son/daughter. If such coverage is changed, lapses or terminates for any reason, I hereby agree to update and supplement the information provided and to ensure that the Mississippi Association of Coaches and its representatives are provided with current information relating to insurance up and through the date of the Tournament.

Attestation

I agree to the terms of the Statement of Understanding and Notice of Insurance Coverage listed above.

Photography Release

I give the Mississippi Association of Coaches and its assigns, licensees and legal representatives the irrevocable right to use any picture or image or sound recording of the student in all forms and media and in all manners, for any lawful purposes. In addition, I consent to the disclosure, by my child’s/ward’s school, to the MAC, upon its request, of all records relevant to his/her eligibility and participation including, but not limited to, his/her records relating to enrollment and attendance, academic standing, age, discipline, residence and physical fitness.*

Yes
No

Payment

Swimming Fee*

Price: $50.00

Credit Card*

Card Details

Cardholder Name

SIGNATURES

Your signatures below attest to your understanding of the information collected in this form. An email will be sent with copies of this information.

Athlete Signature*

Parent or Guardian Name #1*

First Last

Parent Signature*

Parent or Guardian Name #2

First Last

Parent Signature

2025 Swimming- Player Participation Packet

PLAYER ACCEPTANCE

CONSENT TO MEDICAL TREATMENT

Part III

PLAYER GENERAL RELEASE

STATEMENT OF UNDERSTANDING AND NOTICE OF INSURANCE COVERAGE

Photography Release

Payment

SIGNATURES