STUDENT ATHLETE REQUIRED DOCUMENTATION

Transcription

1 Madras Middle School Athletics 240 Edgeworth Road, Newnan, GA Phone: Fax: Principal, Lorraine Johnson Athletic Director, Herbert Betts STUDENT ATHLETE REQUIRED DOCUMENTATION Students who wish to participate in the various athletics offered at any Coweta County Middle School need to have the correct paperwork completed and turned in to the appropriate coach prior to any practice or tryout. Paperwork consists of: 1. Physical Evaluation Form (signed and dated by physician) 2. Form for Emergency Medical Treatment, Extra-Curricular Authorization and Injury Awareness, including proof of insurance (signed by parent or legal guardian) 3. Warning Video Statement (signed by parent or legal guardian) This short video may be viewed at: 4. Hot Weather Practice Procedures Certificate of Receipt (signed by parent or legal guardian) 5. Student/Parent Concussion Awareness Form (signed by both parent/legal guardian and student athlete) 6. CCMS Student Athlete Participation Guidelines (Keep guidelines; return contract signed by parent/legal guardian and student.) 7. Copy of Most Recent Report Card (must not have failed more than 1 class the previous semester) 1. Current Physical Evaluation Each participant must have a certificate of an annual physical examination on file at the school prior to participating in athletic try-outs, practices, or games that indicates the student is physically approved for participation. Physical exams will be good for twelve months from the date of the exam. EXCEPTION: any physical examination taken on or after April 1 in the preceding year will be accepted for the following (GHSA) school year. The physical exam must be conducted by a licensed medical physician, or doctor of Osteopathic medicine, or a physician's assistant. The exam must be signed by a doctor, but the doctor's stamp is acceptable if it is in script, and information appears elsewhere on the form identifying him or her as a medical doctor. It is required that all students use the physical examination form approved by the American Academy of Pediatrics that is found in the GHSA Forms Notebook. The form must have Revised 7/1/2005 Mandatory in the upper left corner of the History page. 2. Form for Medical Treatment and Proof of Insurance All athletes must have insurance to participate. Insurance information must be included with their paperwork. Coweta County middle schools will not endorse any insurance. Should an athlete's family not have coverage, they should be encouraged to purchase their own or purchase the insurance provided through the school. The school-type insurance will cover athletic participation. If Medicaid is listed as the insurance, the athlete's Medicaid number should be on his or her paperwork. It will be the parent's responsibility to maintain current insurance information at the school. 3. Signed Warning Film Statement All student athletes' parent/guardian must view the current year warning film and sign this form stating they have full understanding of the dangers involved in participating athletics. (The warning film may be viewed on the Athletics Page of the Madras website.)

2 Madras Middle School Athletics 240 Edgeworth Road, Newnan, GA Phone: Fax: Principal, Lorraine Johnson Athletic Director, Herbert Betts 4. Hot Weather Practice Procedures (Heat Index) All parents (or legal guardian) must sign this form stating they understand hot weather practice procedures. 5. Student/Parent Concussion Awareness Form (signed by both parent and student athlete) Parents (or legal guardian) and student athlete are required to sign the Student/Parent Concussion Awareness Form stating they have read and understand the dangers of concussions, the common signs and symptoms of concussions, and the GHSA Concussion Policy. 6. Signed Coweta County Middle School Student Athlete Contract All student athletes and their parents (or legal guardian) must sign this form stating they have full understanding of the guidelines set forth in the Coweta County Middle School Student Athlete Participation Guidelines. 7. Report Card from the Previous Semester Each participant must pass four (4) out of five (5) subjects (literature/language arts, math, science, social studies, and connections) the semester previous to the proposed semester of participation for the school calendar year. Each subject must be passed with a minimum grade of 70. Transfer students from out of county may not have more than one (1) failing grade and be eligible to participate. The connections grades of the previous semester will be averaged as one of the subjects. Each school is to send an eligibility form to the commissioner prior to the first contest for a sport.

3 Preparticipation Physical Evaluation HISTORY FORM (Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.) Date of Exam Name Date of birth Sex Age Grade School Sport(s) Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking Do you have any allergies? Yes No If yes, please identify specific allergy below. Medicines Pollens Food Stinging Insects Explain Yes answers below. Circle questions you don t know the answers to. GENERAL QUESTIONS Yes No 1. Has a doctor ever denied or restricted your participation in sports for any reason? 2. Do you have any ongoing medical conditions? If so, please identify below: Asthma Anemia Diabetes Infections Other: 3. Have you ever spent the night in the hospital? 4. Have you ever had surgery? HEART HEALTH QUESTIONS ABOUT YOU Yes No 5. Have you ever passed out or nearly passed out DURING or AFTER exercise? 6. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise? 7. Does your heart ever race or skip beats (irregular beats) during exercise? 8. Has a doctor ever told you that you have any heart problems? If so, check all that apply: High blood pressure A heart murmur High cholesterol A heart infection Kawasaki disease Other: 9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, echocardiogram) 10. Do you get lightheaded or feel more short of breath than expected during exercise? 11. Have you ever had an unexplained seizure? 12. Do you get more tired or short of breath more quickly than your friends during exercise? HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No 13. Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)? 14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia? 15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator? 16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning? BONE AND JOINT QUESTIONS Yes No 17. Have you ever had an injury to a bone, muscle, ligament, or tendon that caused you to miss a practice or a game? 18. Have you ever had any broken or fractured bones or dislocated joints? 19. Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace, a cast, or crutches? 20. Have you ever had a stress fracture? 21. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down syndrome or dwarfism) 22. Do you regularly use a brace, orthotics, or other assistive device? 23. Do you have a bone, muscle, or joint injury that bothers you? 24. Do any of your joints become painful, swollen, feel warm, or look red? 25. Do you have any history of juvenile arthritis or connective tissue disease? MEDICAL QUESTIONS Yes No 26. Do you cough, wheeze, or have difficulty breathing during or after exercise? 27. Have you ever used an inhaler or taken asthma medicine? 28. Is there anyone in your family who has asthma? 29. Were you born without or are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ? 30. Do you have groin pain or a painful bulge or hernia in the groin area? 31. Have you had infectious mononucleosis (mono) within the last month? 32. Do you have any rashes, pressure sores, or other skin problems? 33. Have you had a herpes or MRSA skin infection? 34. Have you ever had a head injury or concussion? 35. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems? 36. Do you have a history of seizure disorder? 37. Do you have headaches with exercise? 38. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling? 39. Have you ever been unable to move your arms or legs after being hit or falling? 40. Have you ever become ill while exercising in the heat? 41. Do you get frequent muscle cramps when exercising? 42. Do you or someone in your family have sickle cell trait or disease? 43. Have you had any problems with your eyes or vision? 44. Have you had any eye injuries? 45. Do you wear glasses or contact lenses? 46. Do you wear protective eyewear, such as goggles or a face shield? 47. Do you worry about your weight? 48. Are you trying to or has anyone recommended that you gain or lose weight? 49. Are you on a special diet or do you avoid certain types of foods? 50. Have you ever had an eating disorder? 51. Do you have any concerns that you would like to discuss with a doctor? FEMALES ONLY 52. Have you ever had a menstrual period? 53. How old were you when you had your first menstrual period? 54. How many periods have you had in the last 12 months? Explain yes answers here I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Signature of athlete Signature of parent/guardian Date 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE /0410

4 Preparticipation Physical Evaluation THE ATHLETE WITH SPECIAL NEEDS: SUPPLEMENTAL HISTORY FORM Date of Exam Name Date of birth Sex Age Grade School Sport(s) 1. Type of disability 2. Date of disability 3. Classification (if available) 4. Cause of disability (birth, disease, accident/trauma, other) 5. List the sports you are interested in playing 6. Do you regularly use a brace, assistive device, or prosthetic? 7. Do you use any special brace or assistive device for sports? 8. Do you have any rashes, pressure sores, or any other skin problems? 9. Do you have a hearing loss? Do you use a hearing aid? 10. Do you have a visual impairment? 11. Do you use any special devices for bowel or bladder function? 12. Do you have burning or discomfort when urinating? 13. Have you had autonomic dysreflexia? 14. Have you ever been diagnosed with a heat-related (hyperthermia) or cold-related (hypothermia) illness? 15. Do you have muscle spasticity? 16. Do you have frequent seizures that cannot be controlled by medication? Explain yes answers here Yes No Please indicate if you have ever had any of the following. Atlantoaxial instability X-ray evaluation for atlantoaxial instability Dislocated joints (more than one) Easy bleeding Enlarged spleen Hepatitis Osteopenia or osteoporosis Difficulty controlling bowel Difficulty controlling bladder Numbness or tingling in arms or hands Numbness or tingling in legs or feet Weakness in arms or hands Weakness in legs or feet Recent change in coordination Recent change in ability to walk Spina bifida Latex allergy Explain yes answers here Yes No I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct. Signature of athlete Signature of parent/guardian Date 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

5 Preparticipation Physical Evaluation PHYSICAL EXAMINATION FORM Name Date of birth PHYSICIAN REMINDERS 1. Consider additional questions on more sensitive issues Do you feel stressed out or under a lot of pressure? Do you ever feel sad, hopeless, depressed, or anxious? Do you feel safe at your home or residence? Have you ever tried cigarettes, chewing tobacco, snuff, or dip? During the past 30 days, did you use chewing tobacco, snuff, or dip? Do you drink alcohol or use any other drugs? Have you ever taken anabolic steroids or used any other performance supplement? Have you ever taken any supplements to help you gain or lose weight or improve your performance? Do you wear a seat belt, use a helmet, and use condoms? 2. Consider reviewing questions on cardiovascular symptoms (questions 5 14). EXAMINATION Height Weight Male Female BP / ( / ) Pulse Vision R 20/ L 20/ Corrected Y N MEDICAL NORMAL ABNORMAL FINDINGS Appearance Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency) Eyes/ears/nose/throat Pupils equal Hearing Lymph nodes Heart a Murmurs (auscultation standing, supine, +/- Valsalva) Location of point of maximal impulse (PMI) Pulses Simultaneous femoral and radial pulses Lungs Abdomen Genitourinary (males only) b Skin HSV, lesions suggestive of MRSA, tinea corporis Neurologic c MUSCULOSKELETAL Neck Back Shoulder/arm Elbow/forearm Wrist/hand/fingers Hip/thigh Knee Leg/ankle Foot/toes Functional Duck-walk, single leg hop a Consider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. b Consider GU exam if in private setting. Having third party present is recommended. c Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion. Cleared for all sports without restriction Cleared for all sports without restriction with recommendations for further evaluation or treatment for Not cleared Pending further evaluation For any sports For certain sports Reason Recommendations I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians). Name of physician (print/type) Date Address Phone Signature of physician, MD or DO 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE /0410

6 Preparticipation Physical Evaluation CLEARANCE FORM Name Sex M F Age Date of birth Cleared for all sports without restriction Cleared for all sports without restriction with recommendations for further evaluation or treatment for Not cleared Pending further evaluation For any sports For certain sports Reason Recommendations I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians). Name of physician (print/type) Date Address Phone Signature of physician, MD or DO EMERGENCY INFORMATION Allergies Other information 2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

7 LAST NAME FIRST MIDDLE SCHOOL YEAR EMERGENCY MEDICAL TREATMENT INFORMATION STUDENTS NAME DATE OF BIRTH AGE: PARENT/GUARDIAN NAME HOME PHONE NUMBER PARENT/GUARDIAN WORK NUMBER FAMILY PHYSICIAN PHYSICIAN S PHONE NUMBER SPECIAL MEDICAL CONDITIONS OF STUDENT: STUDENT IS ALLERGIC TO: PERMISSION FOR MEDICAL TREATMENT I/We grant to the school personnel my/our permission to act on my/our behalf in securing medical attention for in case of any medical emergency while participating in said activity. The local emergency facilities have my/our permission to treat for any illness/injury that occurs while participating in said activity wherever conducted. I/We also understand that I/We are totally responsible for any costs incurred for medical attention. I/We further verify that is covered under the following insurance policy: Name of Insurance Company: Policy No. Named Insured: Persons Covered: Policy Expiration Date: PARENT S SIGNATURE: EXTRA-CURRICULAR AUTHORIZATION FORM I/We desiring that participate fully in various interscholastic and extra-curricular activities available through the Coweta County School System hereby authorize and grant my/our permission for to participate in the following extra-curricular activities. I/We realize that such activities involve the potential for injury, which is inherent in all extracurricular or sporting events. I/We hereby acknowledge that even with the best teaching and coaching, the use of the most advanced equipment and the requirement of strict observance of all rules, injuries are still possible. I/We further realize that injuries received can be so severe as to result in total disability, paralysis, or even death. I/We hereby acknowledge that I/we have read and understand this warning and I/we hereby give my/our permission for to participate in ALL SPORTS and verify that he/she is covered by a current accident and/or health insurance policy. INJURY AWARENESS FORM I have viewed the Injury Awareness Film regarding the possibility of injury in extra-curricular activities for the folloiwng student: STUDENT S NAME GRADE I have viewed the Injury Awareness Film regarding the possibility of injury in extra-curricular activities for another son/daughter at a previous time. STUDENT S NAME GRADE I/We hereby acknowledge that I/We have read, understand and completed this document with full and complete understanding of its terms and that the information contained herein is true and correct. I/We give permission for my/our student to accompany any school team of which the student is a member on any of its local or out of town trips. This day of, 20. PARENT(S) / GUARDIAN(S) SIGNATURE: DATE

8 Madras Middle School Athletic Warning Video Verification I have seen the WARNING FILM on the dangers of athletic participation, and I understand the dangers of my child participating in any sport at Madras Middle School. Date: Name of Student/Athlete: Parent/Guardian Signature: Madras Middle School Athletic Department 240 Edgeworth Road Newnan, GA PH: FAX

9 Madras Middle School Athletics Madras Middle School Practice Procedures for High Heat and Humidity The Coweta County School System and Madras Middle School are concerned about the health and safety of all student athletes. In accordance with GHSA regulations, Coweta County Schools and Madras have developed High Heat and Humidity Practice Procedures. These procedures follow GHSA and American College of Sports Medicine recommendations. All coaches are required to follow all procedures and mandates in order to insure the health and safety of student athletes. The safety of our student athletes is a top priority of coaches and administrators at Madras. By adhering to the procedures outlined and with proper nutrition, hydration, and conditioning of athletes, the risk of heat related injuries can be minimized. ** Return this page signed and dated to the head coach or to the bookkeeper Christy Henry in the Madras front office. ** Certificate of Receipt for Practice Procedures for High Heat and Humidity and Football Preseason Practice Regulations (if playing football) By signing below I, parent/guardian of, acknowledge that I have received a copy of the Practice Procedures for High Heat and Humidity and the Football Preseason Practice Regulations (if playing football) for my child s school. I understand that I may contact the head coach, athletic director (Herbert Betts), or the principal if I have any questions. Parent Signature Date

10 Practice Policy for Heat and Humidity Schools must follow the statewide policy for conducting practices and voluntary conditioning workouts in all sports during times of extremely high heat and/or humidity that will be signed by each head coach at the beginning of each season and distributed to all players and their parents or guardians. The policy shall follow modified guidelines of the American College of Sports Medicine in regard to: 1. The scheduling of practices at various heat/humidity levels 2. The ratio of workout time to time allotted for rest and hydration at various heat/humidity levels 3. The heat/humidity level that will result in practice being terminated A scientifically approved instrument that measures Wet Bulb Globe Temperature (WBGT) reading must be utilized at each practice to ensure that the written policy is being followed properly. WBGT READING ACTIVITY GUIDELINES & REST BREAK GUIDELINES UNDER 82.0 Normal activities --Provide at least three separate rest breaks each hour of minimum duration of 3 minutes each during workout Use discretion for intense or prolonged exercise; watch at-risk players carefully; Provide at least three separate rest breaks each hour of a minimum of four minutes duration each Maximum practice time is two hours. For Football: players restricted to helmet, shoulder pads, and shorts during practice. All protective equipment must be removed for conditioning activities. For all sports: Provide at least four separate rest breaks each hour of a minimum of four minutes each Maximum length of practice is one hour, no protective equipment may be worn during practice and there may be no conditioning activities. There must be 20 minutes of rest breaks provided during the hour of practice. OVER 92 No outdoor workouts; Cancel exercise; delay practices until a cooler WBGT reading occurs GUIDELINES FOR HYDRATION AND REST BREAKS 1. Rest time should involve both unlimited hydration intake (water or electrolyte drinks) and rest without any activity involved. 2. For football, helmets should be removed during rest time. 3. The site of the rest time should be a cooling zone and not in direct sunlight. 4. When the WBGT reading is over 86: a. Ice towels and spray bottles filled with ice water should be available at the cooling zone to aid the cooling process. b. Cold immersion tubs must be available for practices for the benefit of any player showing early signs of heat illness. DEFINITIONS 1. PRACTICE: The period of time that a participant engages in a coach-supervised, school-approved sport or conditioning-related activity. Practices are timed from the time the players report to the field until they leave. 2. WALK THROUGH: This period of time shall last no more than one hour, is not considered to be a part of the practice time regulation, and may not involve conditioning or weight-room activities. Players may not wear protective equipment. Head Coach s Signature

11 Cool Zones for Spring and Fall Sports Each fall and spring sport is required to have a designated cool zone and cooling station. Below are the cooling zone locations for each Madras athletic team that practices in the fall or spring. Sport Football Volleyball Soccer Pep Squad Track Cool Zone or Station Location Cooling Station/Zone with emersion tub located at far end of gym (eastern end); Additional Cooling Zone in cafeteria as needed Cooling Station with emersion tub located at far end of gym (eastern end); Cooling Zone in band room Cooling Station/Zone with emersion tub located at far end of gym (eastern end); Additional Cooling Zone in cafeteria as needed Cooling Station with emersion tub located at far end of gym (eastern end); Cooling Zone in cafeteria Cooling Station/Zone with emersion tub located at the eastern side of cafeteria; Additional Cooling Zone in cafeteria as needed Heat Index Measurement and Record Madras Middle School will use the GHSA Heat Index Measurement and Record Form to record all WBGT readings. Readings will be taken at the start of practice and at the discretion of the coach. A copy of the form will be kept on file and submitted to the athletic director and principal daily. Fluid Replacement and Heat Illness Information Every athlete is given educational information on Fluid Replacement Guidelines and Heat Illness Symptoms and Treatments. Parents/Guardians and athletes should use this information to assist in recovery from practices in warm weather conditions. Fluid Replacement Information (National Athletic Trainers Association-NATA) Athletes should hydrate during the school day prior to practice or competition. Weight Lost During Workout Fluid Amount Needed to Refuel 2 pounds 32 oz. (4 cups or 1 sports drink bottle) 4 pounds 64 oz. (8 cups or 2 bottles) 6 pounds 96 oz. (12 cups or 3 bottles) 8 pounds 128 oz. (16 cups or 4 bottles) Guidelines for hydration during exercise 1. Drink oz. of fluid 1 to 2 hours before the workout or competition. 2. Drink 4-8 oz. of water or sports drink during every 20 minutes of exercise. 3. Drink before you feel thirsty. When you feel thirsty, you have already lost needed fluids. Heat Illness Symptoms and Treatments (National Athletic trainers Association-NATA) Heat Cramps Symptoms 1. Muscle symptoms caused by an imbalance of water and electrolytes in muscles 2. Usually affects the legs and abdominal muscles Treatments 1. Rest in cool place 2. Drink plenty of fluids 3. Proper stretching and massaging 4. Application of ice in some cases Heat Exhaustion Symptoms 1. Can be precursor to heat stroke 2. Normal to high temperature 3. Heavy sweating 4. Skin is flushed or cool and pale 5. Headaches, dizziness 6. Rapid pulse, nausea, weakness 7. Physical collapse may occur 8. Can occur without prior symptoms, such as cramps Treatments 1. Get to a cool place immediately 2. Drink plenty of fluids 3. Remove excess clothing 4. In some cases, immerse body in cool water Heat Stroke Symptoms 1. Body s cooling system shuts down 2. Increased core temperature of 104 degrees or greater 3. Sweating stops 4. Shallow breathing and rapid pulse 5. Possible disorientation or loss of consciousness 6. Possible irregular heartbeat and cardiac arrest 7. If untreated could cause damage to brain or internal organs, and even death Treatments 1. Call 911 immediately 2. Cool bath with ice packs near large arteries such as neck, armpits and groin 3. Replenish fluids by drinking or intravenously

12 Football Preseason Practice Regulations The following regulations were adopted by the State Executive Committee at its meeting on March 19, 2012 and went into effect beginning the school year: Football practice may begin five consecutive weekdays prior to August 1st (July 25th in 2013). 1. In the first five days of practice for any student, the practice shall not last longer than 2 hours, and the student shall not wear more than shorts, helmet, mouthpiece, and shoes. (NOTE: The time for a session shall be measured from the time the players report to the field until they leave the field.) 2. Beginning August 1st, any student may practice in full pads and may practice two times in single calendar day under the following stipulations: a. A student must have participated in five conditioning practices wearing shorts and helmet before being allowed to practice in full pads b. If multiple workouts are held in a single day: i. No single session may last longer than 3 hours ii. The total amount of time in the two practices shall not exceed 5 hours. iii. There must be at least a 3-hour time of rest between sessions iv. There may not be consecutive days of two-a-day practices. All double-session days must be followed by a single-session day or a day off c. These procedures are derived from recommendations created by the Inter-Association Task Force for Preseason Secondary School Athletics Participants in the research paper Preseason Heat-Acclimatization Guidelines for Secondary School Athletics.

13 Student/Parent Concussion Awareness Form Dangers of Concussion Concussions at all levels of sports have received a great deal of attention and a state law has been passed to address this issue. Adolescent athletes are particularly vulnerable to the effects of concussion. Once considered little more than a minor ding to the head, it is now understood that a concussion has the potential to result in death, or changes in brain function (either short-term or long-term). A concussion is a brain injury that results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain, and even death. Player and parental education in this area is crucial that is the reason for this document. Refer to it regularly. This form must be signed by a parent or guardian of each student who wishes to participate in Coweta County Middle School Athletics. One copy needs to be returned to the school, and one retained at home. Common signs and symptoms of concussion Headache, dizziness, poor balance, moves clumsily, reduced energy level/tiredness Nausea or vomiting Blurred vision, sensitivity to light and sounds Fogginess of memory, difficulty concentrating, slowed thought processes, confused about surroundings or game assignments Unexplained changes in behavior and personality Loss of consciousness (NOTE: This does not occur in all concussion episodes.) By-law 2.68: GHSA Concussion Policy: In accordance with Georgia law and national playing rules published by the National Federation of State High School Associations, any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion shall be immediately removed from the practice or contest and shall not return to play until an appropriate health care professional has determined that no concussion has occurred. (NOTE: An appropriate health care professional may include, licensed physician (MD/DO) or another licensed individual under the supervision of a licensed physician, such as a nurse practitioner, physician assistant, or certified athletic trainer who has received training in concussion evaluation and management. a) No athlete is allowed to return to a game or a practice on the same day that a concussion (a) has been diagnosed, OR (b) cannot be ruled out. b) Any athlete diagnosed with a concussion shall be cleared medically by an appropriate health care professional prior to resuming participation in any future practice or contest. The formulation of a gradual return to play protocol shall be a part of the medical clearance. c) It is mandatory that every coach in each GHSA sport participate in a free, online course on concussion management prepared by the NFHS and available at at least every two years beginning with the school year. d) Each school will be responsible for monitoring the participation of its coaches in the concussion management course, and shall keep a record of those who participate. I have read this form and I understand the facts presented in it. Student Signature Parent Signature Date

14 COWETA COUNTY MIDDLE SCHOOL STUDENT ATHLETE PARTICIPATION GUIDELINES The following guidelines are a requirement. These regulations take precedence over all others and may be revised, interpreted, or changed without notice. Purposes A. The purposes of athletics are to promote and uphold school spirit, to encourage a sense of good sportsmanship among students, to build better relationships between schools during athletic events, and to develop basic athletic skills. B. A student athlete must be a positive reflection of the school, both in and out of uniform. Requirements for Tryouts-Eligibility A. Candidates must have a written permission form, a completed physical form, proof of valid insurance coverage, and a signed athletics contract stating full understanding of the guidelines, and a completed emergency release form before being allowed to tryout or practice. B. The student must pass four of the five following subjects: literature/language art, math, science, social studies, and connections classes. The final grades in the connections subjects will be averaged to obtain a final grade for the connections sequence. C. At the conclusion of each semester, eligibility will be reviewed. Team members who have not met eligibility requirements will be dismissed from the team. Participation A. Student athletes are expected to be at all athletic activities of which they are team members. When one person is absent, the entire practice and/or game is adversely affected. B. All members must attend every activity, practice, or game as specified by the coach except in extreme cases of emergency or illness, in which case the coach should be notified prior to the event. C. Excused absences include illness, death in the family, or a pre-approved school-related activity. (If another school-related activity conflicts with the athletics schedule, the coach must be informed prior to the event and provide approval for the event.). These are the only reasons a student athlete may be excused from any function. Absences related to illness may require verification by a note from a doctor, and you must notify the coach before missing a scheduled event. D. After two unexcused absences, the student athlete may be dismissed from the team at the discretion of the coach, athletic director, and/or administrator. E. Tardiness to any function or leaving early from any function may result in additional physical conditioning or probation, at the discretion of the coach, athletic director, and/or administration. All punishments must be satisfied before the athlete will be allowed to participate in the next function, including practices, games, or other events. If this is a frequent problem or if late notice is given, the amount of time being late to/leaving from practice can add up to an unexcused day of practice and may result in dismissal from the team at the discretion of the coach, athletic director, and/or administrator. F. All student athletes must be present for at least one half of the school day in order to be eligible to participate in any function that day, including practices, games, or other events. Appropriate Behavior Inappropriate behavior is not acceptable and may result in additional physical conditioning, probation, and/or dismissal from the team at the discretion of the coach, athletic director, and/or administration. Inappropriate behaviors may include but are not limited to the following: A. Using personal cell phones without permission during practices or games B. Holding hands, kissing, or any other show of public affection at school, athletic events, or any other school-sponsored activity C. Cursing or vulgar language D. Unsportsmanlike conduct E. Disrespect to other team members F. Smoking or use of alcohol or drugs on or off campus Misbehavior at school, discipline referrals, or suspensions from school, may result in probation or dismissal from the team at the discretion of the coach, athletic director, and/or administration. If a student athlete is placed on probation, he or she must sit with the coach the entire length of the activity with no socializing.

15 Purchases A. Any additional athletic equipment or apparel required for a sport that the school does not provide must be GHSA and National Federation of High Schools approved. B. If a student is dismissed from a team by the coach, athletic director, and/or administration or chooses to no longer participate on the team, the student will not be refunded any money paid for uniforms, equipment, dues, etc. Appearance, Uniforms, and Equipment A. For safety purposes, long hair must be pulled back for all practices and games. B. Jewelry of any kind may not be worn to any practice or game. C. Student athletes may not have nails that can be seen over the fingertips (No acrylic or gel nails). D. All team issued uniforms are property of Coweta County School System. E. Uniforms, whether county property or purchased by the participant, will not be worn except for games and designated activities. F. Lost or damaged uniforms are the responsibility of the student athlete. If uniforms are lost or damaged, the participant must pay for the cost of replacing the uniform before being allowed to participate in any other athletic event. G. Coaches may require participants to dress in a uniform manner at school on specified game days. The dress may include the team uniform, tee-shirt, shirt and tie, nice pants, etc. Transportation A. For away games, all team members will be transported to athletic events away from school in the transportation provided by the school. Transportation may or may not be provided after the event. Participants must be picked up from games at times designated by the coach. Parents must sign their child out before they are allowed to leave. If a parent does not sign a child out at an away athletic event, the child may be placed on probation or dismissed from the team. B. For home games and practices, parents are to be at school to pick up their child at the time designated by the coach. Athletes should NOT plan to call a parent at the end of an event in order to schedule a ride. Parents should be waiting on students, not students waiting on parents. C. Participants may not ride home with anyone other than their parent or guardian unless a written note is presented to the coach. Failure to be picked up on time may result in verbal warnings, written warnings, or possible probation or dismissal from the team. (Please sign and return contract on the following page.)

16 COWETA COUNTY MIDDLE SCHOOL STUDENT ATHLETE CONTRACT I have read the Student Athlete Guidelines and agree to abide by the outlined policies. I also understand that I must abide by policies outlined in the Coweta County Middle School Student Handbook and the Coweta County Board of Education Student s Code of Conduct while on campus and at all school/athletics events. I realize that failure to adhere to the policies outlined in these three documents could jeopardize my continued participation in the Middle School Student Athlete Program. Student Signature Date Parent/Legal Guardian Signature Date