Early Dismissal and Transportation Permission Form
(Click on Above Link for Form)
This is ONLY for the PIL District meet on Monday, Oct. 24th. Until I can fix the form, cross off the old date and put in Oct. 24, 2022. The Process:
1) The parent must fill-out the form
2) Send the form to School with Student/Athlete Monday, Oct 25th
3) At 2:30pm they will show the form to his/her teacher
4) The teacher will release the Student/Athlete from class
5) Promptly change into their Wells Youth XC Jerseys
6) Meet coaches at the front of the school by the buses
7) Present form to the coaches and get on the bus
This form MUST be filed out by/on Monday, Oct 24th and sent to school.
If they DO NOT have this form the teacher WILL NOT allow them to leave class.
*This will be strictly enforced per the Front Offices at Jackson and Robert Gray Middle School*
To participate, all students must have the following by their first practice:
1. A physical exam every two years. Students may not participate without a current clearance.
2. The following completed and turned in to the coordinator or coaches (links to forms below):
(Click on Above Link for Form)
This is ONLY for the PIL District meet on Monday, Oct. 24th. Until I can fix the form, cross off the old date and put in Oct. 24, 2022. The Process:
1) The parent must fill-out the form
2) Send the form to School with Student/Athlete Monday, Oct 25th
3) At 2:30pm they will show the form to his/her teacher
4) The teacher will release the Student/Athlete from class
5) Promptly change into their Wells Youth XC Jerseys
6) Meet coaches at the front of the school by the buses
7) Present form to the coaches and get on the bus
This form MUST be filed out by/on Monday, Oct 24th and sent to school.
If they DO NOT have this form the teacher WILL NOT allow them to leave class.
*This will be strictly enforced per the Front Offices at Jackson and Robert Gray Middle School*
To participate, all students must have the following by their first practice:
1. A physical exam every two years. Students may not participate without a current clearance.
2. The following completed and turned in to the coordinator or coaches (links to forms below):
- Physical Clearance Form (if not done in last two years) - The exam can be taken at the Cleveland High School Health Center. Additional information on school-based health centers is below.
- Cross Country Participation Form
- Emergency Medical Information Form
- Off Campus Running Permission Form
- Participation Fee - Paid with a check made to PIL Athletics, memo: Child’s name. $200 or $60 for students on free and reduced lunch programs. The participation fee also includes a Nike Wells Youth Cross Country hoody.
- Be passing all classes with a 2.0 (or, probationary, below 2.0 or 2.5 with one F)
- Be attending school on day of practice or meet
- Remain drug & alchohol free
Cleveland High School Health Center
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 outof-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-healthcenters (Click on button below.)