H. E. WINKLER ATHLETICS

Transcription

1 H. E. WINKLER ATHLETICS ATHLETIC PARTICIPATION FORMS SCHOOL YEAR: NAME: GRADE:

2 To: Parents/Guardians of prospective student athletes From: HWMS Athletics Department Re: Athletic participation forms The athletics department of Harold E. Winkler Middle School is excited that your child has displayed interest in participating in athletics. Becoming a part of an athletic team provides opportunities for the student athlete to grow in areas such as physical fitness, sportsmanship, and teamwork. Being part of an athletic team requires hard work and dedication from the athlete and you. Attached you will find a packet of athletic forms that must be fully and properly completed before a student athlete can try out for a team or participate in skill development. Please read these forms thoroughly and completely. Should you have any questions or concerns about the information on these forms, feel free to contact your child s prospective coach or the Athletic Director at the school. 1. Physical Form (Sport Pre participation Examination Form) This form must be completed by you (front side) and a physician (back side) each calendar year. Please explain any YES answers in the blanks provided on the front. There must be a physician s signature and date for the form to be valid. **The physical will be valid for 365 days. 2. Insurance Forms This form is front and back. Front side: Please fill in the student athlete s name and sports they are interested in. Then check a, b, or c on number 3. (If you need to purchase school insurance, #3 explains how to go about that.) Please sign and date the form as well. Back side: Please fill in all information regarding the demographics of the studentathlete. Insurance company name AND policy number must be on this side. Student athlete and parent/guardian MUST sign and date the bottom. **These forms are good for one school year. If your insurance changes, for any reason, please submit a new form. 3. Concussion Form Please read the education page first. After you have read the concussion information page then you AND your student athlete will need to fill out the Concussion Statement. Both parties must initial where appropriate then sign and date the document. **This form is good for one school year. 4. Emergency Card All coaches are required to keep emergency information for their players at all times. This form is given to them in the case of an injury and they need to contact you. Please fill out the form in its entirety. This form also gives our Athletic Trainer permission to treat your student athlete should they get injured. **This form is good for one school year. 5. Please read through all other forms carefully. Then fill them out and sign and date them accordingly. **They will be good for one school year. Please do not turn in any incomplete forms. Wait until you have everything filled out completely and correctly before turning them in. The forms may be turned into the Athletic Forms box in the Main Office or the Athletic Forms box beside the boys locker room. Again, thank you for your s and your child s interest in being part of the Harold E. Winkler Middle School Athletic Program. We look forward to a great season! Sincerely, The Athletics Department at H. E. Winkler Middle School

3 NORTH CAROLINA HIGH SCHOOL ATHLETIC ASSOCIATION SPORT PREPARTICIPATION EXAMINATION FORM Patient s Name: Age: Sex: This is a screening examination for participation in sports. This does not substitute for a comprehensive examination with your child s regular physician where important preventive health information can be covered. Athlete s Directions: Please review all questions with your parent or legal custodian and answer them to the best of your knowledge. Parent s Directions: Please assure that all questions are answered to the best of your knowledge. If you do not understand or don t know the answer to a question please ask your doctor. Not disclosing accurate information may put your child at risk during sports activity. Physician s Directions: We recommend carefully reviewing these questions and clarifying any positive or Don t Know answers. Explain Yes answers below Yes No Don t know 1. Does the athlete have any chronic medical illnesses [diabetes, asthma (exercise asthma), kidney problems, etc.]? List: 2. Is the athlete presently taking any medications or pills? 3. Does the athlete have any allergies (medicine, bees or other stinging insects, latex)? 4. Does the athlete have the sickle cell trait? 5. Has the athlete ever had a head injury, been knocked out, or had a concussion? 6. Has the athlete ever had a heat injury (heat stroke) or severe muscle cramps with activities? 7. Has the athlete ever passed out or nearly passed out DURING exercise, emotion or startle? 8. Has the athlete ever fainted or passed out AFTER exercise? 9. Has the athlete had extreme fatigue (been really tired) with exercise (different from other children)? 10. Has the athlete ever had trouble breathing during exercise, or a cough with exercise? 11. Has the athlete ever been diagnosed with exercise-induced asthma? 12. Has a doctor ever told the athlete that they have high blood pressure? 13. Has a doctor ever told the athlete that they have a heart infection? 14. Has a doctor ever ordered an EKG or other test for the athlete s heart, or has the athlete ever been told they have a murmur? 15. Has the athlete ever had discomfort, pain, or pressure in his chest during or after exercise or complained of their heart racing or skipping beats? 16. Has the athlete ever had a seizure or been diagnosed with an unexplained seizure problem? 17. Has the athlete ever had a stinger, burner or pinched nerve? 18. Has the athlete ever had any problems with their eyes or vision? 19. Has the athlete ever sprained/strained, dislocated, fractured, broken or had repeated swelling or other injury of any bones or joints? Head Shoulder Thigh Neck Elbow Knee Chest Hip Forearm Shin/calf Back Wrist Ankle Hand Foot 20. Has the athlete ever had an eating disorder, or do you have any concerns about your eating habits or weight? 21. Has the athlete ever been hospitalized or had surgery? 22. Has the athlete had a medical problem or injury since their last evaluation? FAMILY HISTORY 23. Has any family member had a sudden, unexpected death before age 50 (including from sudden infant death syndrome [SIDS], car accident, drowning)? 24. Has any family member had unexplained heart attacks, fainting or seizures? 25. Does the athlete have a father, mother or brother with sickle cell disease? Elaborate on any positive (yes) answers: By signing below I agree that I have reviewed and answered each question above. Every question is answered completely and is correct to the best of my knowledge. Furthermore, as parent or legal custodian, I give consent for this examination and give permission for my child to participate in sports. Signature of parent/legal custodian: Date: Signature of Athlete: Date: Phone #:

4 Physical Examination (Must be Completed by a Licensed Physician, Nurse Practitioner or Physician Assistant) Athlete s Name Age Date of Birth Height Weight BP ( % ile) / ( % ile) Pulse Vision R 20/ L 20/ Corrected: Y N These are required elements for all examinations NORMAL ABNORMAL ABNORMAL FINDINGS PULSES HEART LUNGS SKIN NECK/BACK SHOULDER KNEE ANKLE/FOOT Other Orthopedic Problems HEENT ABDOMINAL GENITALIA (MALES) HERNIA (MALES) Clearance: A. Cleared Optional Examination Elements Should be done if history indicates B. Cleared after completing evaluation/rehabilitation for : *** C. Medical Waiver Form must be attached (for the condition of: ) D. Not cleared for: Collision Contact Due to: Non-contact Strenuous Moderately strenuous Non-strenuous Additional Recommendations/Rehab Instructions: Name of Physician/Extender: Signature of Physician/Extender MD DO PA NP (Signature and circle of designated degree required) Date of exam: Address: Physician Office Stamp: Phone (*** The following are considered disqualifying until appropriate medical and parental releases are obtained: post-operative clearance, acute infections, obvious growth retardation, uncontrolled diabetes, severe visual or auditory impairment, pulmonary insufficiency, organic heart disease or Stage 2 hypertension, enlarged liver or spleen, a chronic musculoskeletal condition that limits ability for safe exercise/sport (i.e. Klippel-Feil anomaly, Sprengel s deformity), history of uncontrolled seizures, absence of/ or one kidney, eye, testicle or ovary, etc.) This form is approved by the North Carolina High School Athletic Association Sports Medicine Advisory Committee and the NCHSAA Board of Directors. This form is reviewed annually, and was last updated April 2013.

5 ATHLETIC INSURANCE INFORMATION FOR PARENTS WAIVER FORM **IMPORTANT** This notification MUST be signed and returned before your son/daughter can participate in this athletic program. Student s full name: Last First Middle Sport(s): For all sports student insurance must be taken unless this insurance waiver form is signed by the parent indicating adequate personal insurance and releasing the Board of Education and its employees from responsibility for any claim due to injuries received while participating in a school-sponsored athletic program. This requirement includes all team tryouts. 1. There are limitations in the Student Accident Insurance coverage. It will not always pay all charges for every accident. Read the description of the current Student Accident Insurance carefully and be sure that you understand 2. Neither the Board of Education nor any of its employees will assume responsibility for claims resulting from injury to your child while he or she is participating in this program. This means that you will have to pay for any necessary medical treatment not covered by the Student Accident Insurance or any personal insurance coverage that you might have. 3. In view of Board Policy No and the current Student Accident Insurance coverage, I wish to proceed as follows (Check one, sign, and return promptly): a. I have adequate personal insurance and release the Board of Education and its employees from any responsibility in this matter. I will notify my child s principal if I change insurance or lose my present coverage for any reason. b. My Son/Daughter is already enrolled in the Student Accident Insurance Program and I understand that I am responsible for payment of any charges not covered by this policy. c. I need to purchase Student Accident Insurance $9/Low Option, $19/Middle Option, or $49/High Option for regular coverage (without extended dental). This coverage applies to all sports except varsity football. I must purchase varsity football coverage and pay an additional fee of $87/Low Option, $143/Middle Option or $317/High Option for regular coverage (without extended dental). Payment can be mailed directly to the insurance company in the brochure provided or enrolled online at I understand that I am responsible for payment of any charges not covered by this policy. If these fees present a financial hardship, I will discuss this with my child s principal. Each player must also receive a MEDICAL EXAMINATION by a duly licensed physician, nurse practitioner, or physician s assistant each calendar year (once every 365 days) in order to be eligible for tryouts, practice, or participation in interscholastic athletic contests. I hereby certify that my son/daughter has met this requirement: SIGNED (Parent or Legal Guardian): DATE: For further information: Please go to the Cabarrus County Schools Web site: Student Services Athletics On Line Documents NC Insurance Brochure Here you will find information on the various coverages offered and enrolling. Revised

6 Cabarrus County Schools Athletic Participation Form Name of Parent/Legal Guardian: (please print) Name of Student-Athlete: (please print) Last First Last First M.I. Relation to student: Street Address: City State Zip Grade Level: Date of Birth: Fathers Work Phone Mothers Work Phone Cell Phones Request for Permission: We, the undersigned student and the student s parent/guardian, apply for permission to participate in interscholastic athletics in the following sports: (Check all that may apply) [ ] Basketball [ ] Football [ ] Softball [ ] Volleyball [ ] Baseball [ ] Golf [ ] Swimming [ ] Wrestling [ ] Cheerleader [ ] Manager/Student Trainer [ ] Tennis [ ] Wrestling mat maid [ ] Cross-Country [ ] Soccer [ ] Track [ ] Student Team Manager General Requirements: We have read and discussed the general requirements of the NCHSAA, Cabarrus County and our school. We understand that additional questions or specific circumstances should be directed to my student s coach, athletic director or principal. Risk of Injury: We acknowledge and understand that there is a risk of injury involved in athletic participation. We understand that the student-athlete will be under the supervision and direction of an athletic coach. We agree to follow the rules of the sport and the instructions of the coach in order to reduce the risk of injury to the student and other athletes. However, we acknowledge and understand that neither the coach nor Cabarrus County can eliminate the risk of injury in sports. Injuries may and do occur. Sports injuries can be severe and in some cases may result in permanent disability or even death. We freely, knowingly, and willfully accept and assume the risk of injury that might occur from participating in athletics. Release: In consideration of CCS allowing the above-named student-athlete participate in athletics, we agree to release and hold CCS, its athletic coaches, and other employed free, harmless and indemnified from and against any and all claims, suits or causes of action arising from or out of any injury that the student-athlete may suffer from participation in athletics other than an injury from gross or willful negligence. Insurance: School Board Policy (#5143) requires that all students who participate in athletics be adequately covered by medical or accident insurance. We certify that we have purchased and will maintain in full force and effect during the student-athlete s participation in athletics the following insurance policy: Check One: [ ] School Accident Insurance [ ] Name of other Insurance Company Date Purchased: Policy No: Policy No: Address: Group No: City: Policy From: State: Zip: To: Certification and Medical Authorization: Permission is hereby granted to the Athletic Director, Athletic Trainer, or Coaching Staff at our Cabarrus County School to proceed with ANY needed medical treatment, ambulance notification, and/or x-ray for the student-athlete. In the event of serious illness or injury, need of surgery, or accidental occurrences, I understand that an attempt will be made by the coaching staff or medical staff to contact the parent by phone. If unsuccessful, needed emergency treatment may be given as necessary for the best interest of the student-athlete. Release of Medical Information: I also give my permission for the treating physician; athletic trainer/first responder to share and/or receive health related information needed my child with other Health care providers, coaches, etc. throughout the school year. We, the undersigned student and parent, have read this document and understand all of the expectations of athletic participation at our Cabarrus County Schools. Student signature: Date address Parent/Guardian Signature Date E Mail Address REVISED

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9 Cabarrus County Emergency Card Please Print Do not leave any blank School: Harold E. Winkler Middle School School Year: Athlete Information: Last Name First Name Middle Initial Birth Date: / / Home Address: Home Phone: Cell Phone: Known Allergies/Illnesses: *If none, then please write NONE* Current Medication(s) Taken: *If none, then please write NONE* Parent Information: Mother s Name: Father s Name Work Phone: Cell Phone: Work Phone Cell Phone: Emergency Contact Name: Phone Number: Insurance Information: Athlete is covered by: (Please check one) School Insurance Policy # Family Insurance If family insurance please complete the following: Name of Company and address: Phone Number: Policy/Group #: Permission to Treat Permission is hereby granted to the Athletic Director, Athletic Trainer, or Coaching staff at our Cabarrus County School to proceed with ANY needed medical treatment, ambulance notification, and/or x ray for the above named student. In the event of serious illness or injury, need of surgery, or accidental occurrences, I understand that an attempt will be made by the coaching or medical staff to contact me by phone. If unsuccessful, needed emergency treatment may be given as necessary for the best interest of the student and a copy of this permission will be furnished to the doctor in charge. I also grant permission for the treating physician to release information to the athletic trainer, and/or health related information needed to care for my child with physicians, coaches, other healthcare providers, etc. throughout the school year. Parent signature: Athlete signature: Date: Date:

10 TO: FROM: Parents or Guardian of Middle and High School Students Involved with the Athletic Program Dr. Barry Shepherd Superintendent DATE: May 2, 2013 SUBJECT: Student/Athletic Accident Insurance Coverage for ALL sports participants (including Junior Varsity and Varsity football) are required to take the student and athletic insurance unless parents complete and sign the waiver form (provided by the head coach), which indicates that parents wish to have their family insurance to cover their son or daughter if they are injured. This requirement includes all team tryouts. Varsity football players must take the football insurance (paid by the parent) if their parents or legal guardians check 3 (c) on the insurance waiver form (see Appendix D-1). Varsity football coverage is available in three options: $87/Low Option, $143/Middle Option, and $317/High Option (without extended dental). Junior varsity football players and all other athletes must take at least the At-School coverage available in three options $9/Low Option, $19/Middle Option, and $49 High Option (without extended dental) so that they are properly covered if their parents or legal guardian check 3(c) on the insurance waiver form. If parent checks 3 (c) and his/her child play varsity football and any other sport, then the parent must purchase the football coverage as well as the regular student coverage. Nationwide Insurance will be the carrier for student/athletic and football accident coverage. This is the company presently endorsed by the North Carolina High School athletic Association (NCHSAA), the North Carolina Athletic Directors Association (NCADA), and the North Carolina School Boards Association (NCSBA). Premium and claims will be handled by K&K Insurance, a national leader in sports and student insurance. All of the coverage is primary and pays up to the limits of the policy (see Appendices D-2 and D-3) regardless of co-insurance benefit payments. If the student has additional insurance coverage, then the companies would coordinate benefits payments. All student and athletic accident insurance coverage will be serviced by the American Advantage Marketing Group, Inc., managed in North Carolina by Lawrence S. Braxton, Carolyn Smith, and Steve Leonard, P.O. Box 505 Waynesville, North Carolina, , or address is ameradvins@bellsouth.net For more information, please visit: americanadvantageinsurance.com If you have any questions, please contact the head coach, Principal or Athletics Director at your child s school. C: Bryan Tyson, Athletics Director Kelly Kluttz, Finance Officer High School Principals Middle School Principals High School Athletic Directors Middle School Athletic Directors

11 ASSUMPTION OF RISK INFORMATION WARNING TO STUDENTS AND PARENTS SERIOUS, CATASTROPHIC AND PERHAPS FATAL INJURY MAY RESULT FROM ATHLETIC PARTICIPATION By its nature, competitive athletics may put students in situations in which SERIOUS, CATASTROPHIC and perhaps FATAL ACCIDENTS may occur. Dear Parents/Guardian: Athletics can be one of the most rewarding aspects of any student s scholastic career. We are proud that your son/daughter has chosen to be a student-athlete and has accepted the responsibility of that DUAL ROLE. It is our hope that you will share in your son/daughter s athletic experience as a spectator and, more importantly, as a source of encouragement at home. Many forms of athletic competition result in violent physical content among players, the use of equipment which may result in accidents, strenuous physical exercise, and numerous other exposures to risk of injury. Students and parents must assess the risks involved in such participation and make their choice to participate in spite of those risks. No amount of instruction, precaution, or supervision will totally eliminate all risk of injury. Just as driving an automobile it involves choice of risk, athletic participation by middle/junior and senior high students may also be inherently dangerous. There have been accidents resulting in death, paraplegia, quadriplegia, and other very serious permanent physical impairment as a result of athletic competition. By granting permission for your child to participate in athletic competition, you, the parent or guardian acknowledge that such a risk exists. By choosing to participate, you, the student, acknowledge that such a risk exists. Students will be instructed in the proper techniques to be used in athletic competition and in the proper utilization of all equipment worn or used in practice and competition. Students must adhere to that instruction and utilization and must refrain from improper uses and techniques. As previously stated, no amount of instruction, precaution, and supervision will totally eliminate all risk of serious, catastrophic, or even fatal injury. If any of the foregoing is not completely understood, please contact your school principal, athletic director, coach or athletic trainer for further information. The following is in compliance with requirements to inform all athletes that any activity involves the potential of injury, which is inherent in sports. I/We acknowledge that even, with the best coaching, use of the most advanced equipment and strict observance of the rules, injuries are still a possibility. On rare occasions these injuries can be severe as to result in total disability, paralysis or even death. I/We acknowledge have read and understand the warning. I have read the rules and guidelines in this attachment and folder governing the athletes at. By signing this form, I affirm the willingness to abide by these rules and meet my commitments. School Student Signature Date Parent(s) Signature Date Date

12 CABARRUS COUNTY FOOTBALL Assumption of Risk FOOTBALL ONLY Football is a contact sport and injuries will occur. The coaches working in our program are well-qualified professional people. Fundamentals related to playing football will continually and repeatedly be emphasized on and off the field. The information contained within the list of rules and procedures is to inform the young men/ women in our football programs of the proper techniques to practice for maximum safety in the contact phase of the game. Serious head and neck injuries leading to death, permanent brain damage or quadriplegia (extensive paralysis from injury to the spinal cord at the neck level occurs each year in football. The toll is relatively small (less than one fatality for every 100,000 players and an estimated one non-fatal severe brain and spinal cord injury for every 100,000 players) but persistent. They cannot be completely prevented due to the tremendous forces occasionally encountered in football collisions; they can be minimized by the manufacturer, coach, and the player compliance with safety standards. TACKLING, BLOCKING AND RUNNING THE BALL By rule, the helmet is not to be used as a ram. Initial contact is not to be made with the helmet. It is not possible to play the game safely or correctly without making contact with the helmet when properly blocking and tackling an opponent. Therefore, technique is most important to prevention of injuries. Tackling and blocking techniques are basically the same. Contact is to be made above the waist but not initially with the helmet. The player should always be in a position of balance, knees bent, back straight, body slightly bent forward, HEAD UP, target area as near to the body as possible with the main contact being made with the shoulder. Blocking and tackling by not putting the helmet as close to the body as possible could result in shoulder injury such as separation or a pinched nerve in the neck area. The dangers of not following the proper techniques can be from minor to disabling to even death. The reason for following the safety rules in making contact with the upper body and helmet is that improper body alignment can put the spinal column in a vulnerable position for injury. If the head is bent downward the cervical (neck) vertebrae are in a bind and contact on the TOP OF THE HELMET could result in a dislocation, nerve damage, paralysis or even death. If the back is not straight, the thoracic (mid back) and lumbar vertebrae are also vulnerable to injury with similar results if contact again is made to the TOP OF THE HELMET. Cabarrus County s daily football workout includes exercises to develop strength in the neck muscles. Strengthening the neck muscles is one of the best methods of preventing neck injury and enabling an individual to hold his head up even after getting tired during the workout or contest. BASIC HITTIING (CONTACT) POSITION AND FUNDAMENTAL TECHNIQUE If the knees are not bent, the chance of knee injury is greatly increased. Fundamentally, a player should be in the proper hitting position at all times during live ball play and this point will be repeated continually during practice. The danger is anything from strained muscles, to ankle injuries, to serious knee injuries with may require surgery. The rules have made blocking below the waist (outside the twoyard by four-yard area next to the football at the line of scrimmage) illegal. Cleats have been restricted to no more than ½ inch to help further prevent knee injuries. A runner with the ball however, may be tackled around the legs. In tackling, the rules prohibit initial contact with the helmet or grabbing the facemask or edge of the helmet. These restrictions were placed in the rules because of serious injuries resulting from Non-compliance to these safety precautions. Initial helmet contact could result in a bruise, dislocation, broken bone, head injury, internal injury such as kidneys, spleen, bladder, etc. Grabbing the facemask or helmet edge could result in a neck injury, which could be anything from a muscle strain to a dislocation, nerve injury, spinal column damage causing paralysis or death. acts. Illegal play by participating athletes shall not be tolerated and all players are repeatedly reminded of the dangers of unsportsmanlike FITTING AND USE OF THE EQUIPMENT Shoulder pads, helmets, hip pads, pants, including high pads and kneepads, must have proper fitting and use. Shoulder pads which are too small will leave the shoulder point vulnerable to bruises and separation; it could also be too tight in the neck area, will slide on the shoulders making them vulnerable to bruises and separations. Helmets must fit snugly at the contact points: front, back and top of the head. The helmet must be safety approved NOCSAE stamped (certified seal); the chin straps must have four contact points to the helmet and must be fastened, and the cheek pads must be the proper thickness. On contact, too tight a helmet could result in a headache. Too loose a fit could result in headaches, concussion, and a face injury such as a broken nose or cheek bone; a blow to the back of the neck causing a neck injury could possibly be quite serious such as paralysis or death. This report does not cover all potential injury possibilities in playing football, but it is an attempt to make the players aware that fundamentals, coaching and proper fitting equipment is important to the safety of those playing football in Cabarrus County. The above information has been explained to me and I understand the list of rules and procedures. I also understand the necessity of using the proper technique while participating in the football program. I understand not to use the helmet to butt, ram, and spear an opposing player. This is a violation of the football rules and such use can result in severe head or neck injury, paralysis, or death and possible injury to opponents. NO helmet can prevent all head or neck injuries a player might receive while participating in football. Athlete s Signature Parent/Guardian Signature Date Date

13 MIDDLE SCHOOL ATHLETIC PARTICIPATION and REQUIREMENTS Protect Your Eligibility; Know the Rules: Academics: Age: Attendance: Domicile: Medical Exam: In grades seven and eight, the student must pass at least one less course than the number of required core courses each semester and meet promotion standards established by the LEA. If an athlete is "academically eligible or "academically ineligible at the beginning of any semester, that status is retained throughout the full semester. It is the responsibility of the school principal to check the academic status of each student/athlete enrolled in school at the beginning and close of a semester. No student may be eligible to participate at the middle school level for a period lasting longer than four (4) consecutive semesters, beginning with the student s entry into seventh grade. The principal shall have evidence of the date of each player s entry into the seventh grade and monitor the four (4) consecutive semesters. In grades seven and eight, a student may not participate on a team if the student becomes 15 years of age on or before August 31 of that school year. Per Conference by-laws, a 7 th grader cannot be 14 on or before August 31 and be eligible to play 7 th grade sports. A player must attend school at least 85% of the previous semester. A student must, at any time of any game in which he or she participates, be a regularly enrolled member of the school s student body, according local policy. Local LEA requires that the student must be present for a minimum of 50% of the student day on the day of an athletic contest or practice in order to participate in the event. The student must meet the residence criteria of G.S. 115C-366(a). The student may participate only at the school to which the student is assigned by the LEA. In order to be eligible for practice or participation in interscholastic athletic contests, the student must receive a medical examination once every 365 days by a duly licensed physician, nurse practitioner, or physician assistant, subject to the provisions of G.S. 90-9, , and Students absent from athletic practice for five (5) or more consecutive days due to illness or injury must receive a medical release from a physician licensed to practice medicine before remittance to practice or contests. NOTE: An athlete becomes eligible or ineligible on the first day of the new semester. Coaches are asked to make certain that athletes are aware of the regulations. Eligibility requirements for middle and high school athletes are as stated in the North Carolina High School Athletic Association Handbook. Eligibility requirements for middle school athletes are also addressed in the North Carolina Public Instruction publication Middle/Junior High School Athletic Manual. The manual can be viewed at the following web address.

14 STUDENT ATHLETE CONTRACT CABARRUS COUNTY SCHOOLS I, realize that participating in athletic at is a privilege. I (Name of Athlete) (School) also understand that I have certain responsibilities that must be maintained in order to represent my school. Conditions for participating in athletics are as follows. 1. I will fulfill all of the eligibility requirements as set forth by the North Carolina High School Athletic Association. 2. I understand that my participation is governed by Board Policy 3620 and that my participation may be restricted if I (1) am charged with criminal conduct; (2) am not performing at grade level; (3) have exceeded the number of absences allowed by Policy 4400; (4) have violated the student conduct standards found in the 4300 series of policies; or (5) have violated school rules for conduct. 3. I will be prompt in completing the required forms from the school. a. Physical Form b. Athletic Participation Forms c. Athletic Contract d. Warning of Injury Form 4. I understand that once I begin a sport, I may not try-out for any other squad until that team s season is completed. 5. I understand that if I decided to quit a sport, I must do so in the manner described in this contract. a. If quitting a sport, I must notify the coach within 36 hours. b. I understand that all equipment issued from the squad is to be returned before any separation from the squad. Equipment not returned will be charged to the students fees and will prevent them entering the next sport. c. Any player who quits a squad during the contest will be suspended from athletics for one year and must have the permission from the principal and athletic director to rejoin the athletic program. 6. I understand that all equipment issued and all bills incurred must be returned or paid before I will be allowed to participate in another sport. 7. I understand it is my responsibility to follow the training rules as set forth by the athletic department/coach. Any violation that results in suspension must be reviewed by the Principal/Athletic Director before I will be allowed to return. Any violation involving the use or possession of drugs or alcohol will result in dismissal from the squad. 8. I understand that to letter in a sport I must fulfill all requirements of the athletic department and the coaches of each team. 9. Squad members must be in school at least half a day on game day/practice day. 10. Members of a squad are to ride to away games together under the supervision of the head coach. This includes trainers, managers and scorekeepers. All members are to ride back after the contest under the supervision of the head coach unless their parent received permission from the head coach in person at the end of the contest to ride with them. Parent must sign off they are taking their child. 11. I understand that I am a representative of the athletic department and that my actions reflect on the school, community, and my family. Any actions that bring discredit to me or these institutions will be dealt with by the administration and the athletic department and may include dismissal from the team. 12. I commit myself to continuously working toward the goal of being a contributing member of an athletic team at my school. To do anything which would harm my body would not be in the best interest of me, my family, my team, and my school. 13. I hereby promise and commit to staying alcohol and drug free during my sports season. I fully understand this pledge extends seven (7) days per week. A breach of this promise will result in dismissal from the team for the remainder of the season. 14. I understand that if I have a problem and/or need help fulfilling this contract, all members of my school s athletic department, the administrative team and counseling department is available and willing to help me. 15. I pledge to be a positive role model to my fellow student athletes/teammates and help them abide by all of the athletic department s rules and policies. 16. If I am removed from a team for disciplinary reasons, I may be prohibited to return to any event involving that team or sport the remainder of the season. In keeping with the sportsmanship and team spirit necessary to have a successful season, it is of the utmost importance that all athletes conduct themselves in a positive manner supporting their team. If deemed that any actions are considered detrimental to the success of the team, that athlete may face disciplinary action as deemed fit by the coach including removal from the team. In signing this statement you are assuring Cabarrus County Schools that you will be a positive team player and will support the team in all your actions. I understand the above statements and will support the team in all actions and deeds. Athlete s Signature Date As the parent/guardian of I understand and support this contract and pledge my child has signed. I also understand that it is my responsibility to assist my child in following the rules and policies listed in the above document. Parent/Guardian Signature Date Revised 5/17/13

15 PLEASE READ THIS PAGE, SIGN and RETURN TO YOUR COACH: ATHLETIC PARTICIPATION REQUIREMENTS FELONY POLICY The NCHSAA Policy on felony charges states that if a student is subject to the 8 semester rule (1) Is convicted of a crime classified as a felony under North Carolina or federal law or (2) is adjudicated delinquent for an offense that would be a felony if convicted by an adult; is not eligible to participate in the NCHSAA sports program effective immediately through the end of the students high school career. NCHSAA STUDENT ATHLETE PLEDGE As a student-athlete, I am a role model. I understand the spirit of fair play while working hard. I will refrain from engaging in all types of disrespectful behavior, including inappropriate language, taunting, taunting, trash talking and unnecessary physical contact. I know the behavior expectations of my school, my conference, and the NCHSAA and hereby accept the responsibility and privilege of representing this school and community as a student athlete. I accept my responsibility to model good sportsmanship that comes from being a student-athlete. NCHSAA PARENT PLEDGE As a parent, I acknowledge that I am a role model. I will remember that school athletics is an extension of the classroom, offering learning experiences for the students. I must show respect from all players, coaches, spectators and support groups. I will participate in cheers that support, encourage and uplift teams involved. Using inappropriate language and taunting are contrary to the spirit of fair play and the good sportsmanship our school and conference and the NCHSAA expect. I hereby accept my responsibility to be a role model of good sportsmanship that comes with being the parent of a student athlete. I certify that the home address as parents shown in this document is my sole bona fide residence, and I will notify the school principal immediately of any change of residence, since such a move may alter the eligibility status of my student/athlete. All other information contained in this form is accurate and current. NCHSAA SPORTSMANSHIP/EJECTION POLICY We acknowledge that, both the student and the parent whose names appear below have read and understand the NCHSAA Sportsmanship/Ejection Policy. We understand that the following types of behavior will result in an ejection from an athletic contest: fighting, taunting, or baiting, profanity directed toward an official or an opponent, obscene gestures, disrespectfully addressing an official. 1 st Ejection: 2 game suspension in all sports except 1 game in football (ejection for fighting doubles the penalty: 4 games in all sports except football, which is a 2 game suspension. 2 nd Ejection: Suspension for the remainder of the sports season 3 rd Ejection: Suspension from all athletic competition for 365 days from the date of the 3 rd ejection. I, the undersigned student and parent, have read this document and understand all of the expectations for athletic participation at my high school ALCOHOL AND DRUG FREE CONTRACT I, hereby promise and commit to staying alcohol and drug free. A breach of promise will result in suspension from participation for the remainder of the current season, including off season workouts. Parents, we also seek your help in making sure that our student/athletes are Alcohol and Drug Free year round. We must control the underage drinking before there is serious injury or death. Student Athlete Signature Date Director of Athletics Parent/Guardian Signature Date Principal Revised 5/21/13