ATHLETIC ENROLLMENT PACKET

Size: px

Start display at page:

Download "ATHLETIC ENROLLMENT PACKET"

Elvin Stone
5 years ago
Views:

ATHLETIC ENROLLMENT PACKET 2018-2019 Name: Grade: Sport: Head Coach: Please attach a copy of

1 ATHLETIC ENROLLMENT PACKET Name: Grade: Sport: Head Coach: Please attach a copy of your most recent report card & a current physical. Physicals are only valid for 1 calendar year.

2 ATHLETICS TRANSPORTATION WAIVER Permission is granted for to be transported by coaches, other parent(s)/ guardian(s) as indicated below while participating in (sport) at estem Public Charter School. I authorize and allow my child to use the following mode(s) of transportation while participating in the school-sponsored activity shown above. Ride in an estem PCS vehicle driven by a school district coach or advisor Initial here if Ride in a commercial vehicle driven by a licensed & insured commercial operator Initial here if Ride in a private vehicle driven by a school district coach or advisor Initial here if Ride in a private vehicle driven by another licensed & insured parent or guardian Initial here if By signing this document, I hereby expressly waive and release any and all rights and claims of any nature whatsoever I /we may have against the estem Public Charter School, the Board of Education, and its members and employees, arising out of, in connection with or resulting from participation in the school activity listed above. Student Signature: Date: Parent/Guardian Signature: Date: 2

3 Athletics Waiver & Release Form Players Name: Date of Birth: Girl or Boy (please circle) Sport Grade Parents Name: Address: City: Zip: Phone (Home): Parents Day # Other Emer. # address: WAIVER & RELEASE In consideration for being permitted by estem Public Charter School to participate in the above activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death or property damage which may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the EPCMS (its officers, employees, volunteers, and agents) from any participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of those risks is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity. PARENTAL CONSENT: (TO BE COMPLETED AND SIGNED BY PARENT/GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE). I hereby consent that my son/daughter, participate in the above activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity. I have carefully read this Agreement, Waiver, and Release and fully understand its contents. I am aware that this is a release of liability and a contract between me and EPCMS and I sign it of my own free will. Signature Date Name Printed 3

4 ATHLETIC PARTICIPATION FEE AGREEMENT Effective July 1, 2017 Parents and Student-Athletes, The estem Athletic Department is constantly seeking to improve our service to our students, parents and supporters. Each year we aim to raise our level of excellence while maintaining our efforts to sustain a viable athletic program. As a part of those efforts, we are requiring that each student who elects to participate in athletics pay the estem Athletic Participation Fee of $50. These funds will help foster our ability to provide a recognizable athletic department that is equipped to provide our students with our short and long term goals of a facility, transportation and the addition of extracurricular activities! This fee does not cover the cost of an athlete s team shoes, required team gear or student athletes contributions to team fundraisers. Each student is still responsible for paying for his/her own shoes, replacing any damaged or missing uniform pieces, for participating in team fundraisers and any other costs deemed necessary by the head coach. Each team s head coach will provide you with a deadline to submit the estem Athletic Participation Fee that should be no later than the first day of competition. All payments should be submitted to the student s head coach or to the Dean of Athletics. Checks should be made payable to estem PCS. The memo line should say Athletics Fee and the student-athlete s name. Any student that is eligible for the Free/Reduced Lunch program has an automatic waiver from paying the participation fee. If this applies, please notify the head coach of your waiver status immediately. Once confirmed by the school Registrar, the fee will be officially waived. Our goal is to get better and ultimately become a competitive force in the athletic community. We appreciate your continued support of estem Athletics and our student-athletes. Thank you! William Brazle Athletic Director, estem Public Charter School Please Detach and Return to the Dean of Athletics Student Athlete s Name: DATE: SPORT: GRADE: Amount Paid: $ Payment Type: CASH CHECK # Money Order # 4

5 Arkansas Activities Association Concussion Fact Sheet for Athletes and Parents WHAT IS A CONCUSSION A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a ding, getting your bell rung, or what seems to be mild bump or blow to the head can be serious. Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost. WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION? Observed by the Athlete Headache or pressure in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Bothered by light Bothered by noise Feeling sluggish, hazy, foggy, or groggy Difficulty paying attention Memory Problems Confusion Does not feel right Observed by the Parent / Guardian, Coach, or Teammate Is confused about assignment or position Forgets an instruction Is unsure of game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows behavior or personality changes Can t recall events after hit or fall Appears dazed or stunned 5 WHAT TO DO IF SIGNS/SYMPTOMS OF A CONCUSSION ARE PRESENT Athlete TELL YOUR COACH IMMEDIATELY Inform parents Seek medical attention Give yourself time to recover Parent / Guardian Seek medical attention Keep your child out of play Discuss play to return to play with coach Address academic needs WHERE CAN I FIND OUT MORE INFORMATION? Center for Disease Control NFHS Free Concussion Course RETURN TO PLAY GUIDELINES 1. Remove immediately from activity when signs/symptoms are present. 2. Release from medical professional required for return (Neuropsychologist, MD, DO, Nurse Practitioner, Certified Athletic Trainer, or Physician Assistant) 3. Follow school district s return to play guidelines and protocol SIGNATURES By signing below, I acknowledge that I have received and reviewed the attached AAA Concussion in Sports Fact Sheet for Athletes and Parents. I also acknowledge and I understand the risks of brain injuries associated with participation in school athletic activity. Athlete s Signature Print Name Date Parent s Signature Print Name Date

6 estem STUDENT-ATHLETE EMERGENCY CONTACT INFORMATION STUDENT S NAME: DATE OF BIRTH: AGE: MEDICAL CONDITIONS: ALLERGIES: CURRENT MEDICATIONS: FAMILY DOCTOR: DOCTOR'S PHONE: PARENT'S / GUARDIAN NAME: HOME PHONE: WORK PHONE: CELL PHONE: ALTERNATE CONTACT'S NAME: HOME PHONE: WORK PHONE: CELL PHONE: NOTES 6

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet

D.M.G. Athletics. The Official Indoor/Outdoor Summer Basketball League. Team Registration Packet D.M.G. Athletics Presents The Official Indoor/Outdoor Summer Basketball League Team Registration Packet Questions: Contact Coach Dawne Gittens at 860-929-7692 or via email at dgittens@bgchartford.org Team