Cleveland Cluster Athletics
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Forms and Fees

What you need Before you play

Athletes may not participate (even at practice) until these forms and fees are turned in. Please email the coordinator if cost is an issue. 

Turn in every season: Permission to play

All athletes will have to complete a registration form and emergency contact form each season. This should be turned in with the participation fee on the first day of practice. 
2017-18trackregistration.pdf
File Size: 159 kb
File Type: pdf
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2016-17_bball___track_registration_em-espanol.pdf
File Size: 203 kb
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2016-17_wrestling_registration_em-espanol.pdf
File Size: 88 kb
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Medical Clearance Forms

Athletes are required to get a Sports Physical every 2 years, but for every season and for every sport a copy of that physical needs to be turned with the registration packet at the beginning of the season. PIL will only accept the Oregon School Activities Association pre-participation examination form, so the Warrior Youth Football physical forms will not satisfy the requirement. 
new_physcial_form_2017.pdf
File Size: 774 kb
File Type: pdf
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spanish_new_physical_form_2017.pdf
File Size: 349 kb
File Type: pdf
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Notes about payment 

In order to ensure your fees are processed promptly and accurately, please: 
  • put your athlete's first and last name on the memo line of your check or money order,
  • or put cash in a sealed envelope with your athlete's name on it. 

The cost for winter and spring sports is $150 unless your athlete receives free or reduced lunch from the district, in that case, it's $35. It is easiest for us if all of your forms and fees are turned in together. Athletes who pay full price in the fall and winter get the spring sport free! Unfortunately, Warrior Youth Football is not a PIL sport, so it does not count as a fall sport toward the fee exemption. Those fees go directly to Warrior Football, not to the Portland Interscholastic League. 

Mandatory for wrestling: Insurance form

This is a part of the fee you paid at the start of the season. Please fill it out and turn it into the coach or coordinator. 

Mandatory for xc & Track & Field ExpeCTATIONS and permissions

 XC & T&F Athletes often run off campus. With this privilege comes extra responsibility. This document contains a contract that athlete and parent need to sign, as well as an opportunity for parents to let us know how they plan to help the team. Please turn this in with permission to play and the physical. Cross country & Track and Field athletes must complete and turn in this document (keep the top page), The top page has good information about the program.
insuranceinfo.pdf
File Size: 554 kb
File Type: pdf
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Mandatory XC - T&F Forms
File Size: 40 kb
File Type: docx
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CHS Health Center Info

The Cleveland school-based Health Center is sponsored by the Multnomah Country Health Department and Portland Public Schools. All school-aged youth who live or attend school in Multnomah County are welcome at the 13 School-Based Health Centers operated by the Health Department.  Any visitor to the clinic who is not a student at Cleveland MUST report to the main office upon entering the school to receive a visitor’s badge.

The Health Center is located in Room 163. All services are confidential. Students are not charged for services received at the Health Center, but Medicaid and other third-party insurers will be billed.

To schedule an appointment, call 503-988-3350. Walk-ins are welcome.

Cost
School-based health centers are funded by insurance, Medicaid, grants and public funds. Providing your insurance information allows us to bill your insurance so we can serve as many students as possible.

If your insurance doesn’t pay for all or part of the cost, you are not responsible for any out-of-pocket expenses for services received from us.

Families with no health insurance or who do not provide insurance information are referred to an eligibility specialist to see if they qualify for the Oregon Health Plan or other insurance. This could fully insure your child for medical, dental and emergency services. We strongly encourage you to apply for this coverage.

About your visit

Appointments are recommended but walk-ins are welcome. Forms are available online for new clients, clients who have not been seen in a year or more, or for any changes to address, phone, and household situation. In order to avoid delays or the possibility of having to reschedule your appointment, please print and complete these forms and bring them with you to your appointment. With advanced notice, we can mail the forms to you. You can also come in and pick them up before your appointment or come at least a half hour prior to your appointment to fill them out. You are welcome to fax them to the clinic.

Sports physicals
Anyone getting a sports physical must have an OR Student Activity Association (OSAA) sports physical clearance form filled out (history section), signed by parent/guardian and brought to their appointment for the provider to complete. This form is also available through most schools’ athletic offices. For a more comfortable physical exam, we suggest you wear shorts to your appointment.

For forms and more information visit https://multco.us/health/school-based-health-centers

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