Mount Morris Central School. Fitness Room. Procedures, Rules, and Required Forms

Transcription

1 Mount Morris Central School Fitness Room Procedures, Rules, and Required Forms

2 Where is the Fitness Room Located? The Mount Morris Central School fitness room is located across from the new gymnasium. What Type of Equipment is Available? The fitness room has a cardiovascular area. Presently there are two Life Fitness 9100 treadmills and one stationary bicycle. This equipment is designed to be used by those of all fitness levels, from beginners to more experienced. There is also a full circuit of Hammer Strength and Life Fitness machines. Using these machines, every muscle in the body can be worked to some degree. Free weights are also available with various benches and dumbbells that range from 5 to 100 pounds in 5-pound increments. Who is Eligible to use the Room? Students in grades 9-12 will use the room as part of their Physical Education class. All teachers who bring students in to use the equipment must have attended a training session on how to properly use the equipment. Coaches who have attended a training session may bring their athletes in to use the room as part of their sports practice. These students must have met the following guidelines: 1. Must have a valid sports physical on file with the school nurse. 2. Must have filled out a participation information form. 3. Must have filled out an informed consent/assumption of risk form. 4. Must have filled out a parental authorization & waiver of claims form. All employees of Mount Morris Central School may use the room providing they have met the following guidelines: 1. Attended a training session. 2. Must have a physician s medical clearance form turned in. 3. Must have filled out a participant information form. 4. Must have filled out an informed consent/assumption of risk form. Students in extracurricular activities (i.e. weight lifting club) will be allowed to use the room with a faculty supervisor who has attended a training session. These students must have met the following guidelines: 1. Must have a physician s medical clearance form turned in or have an updated sports physical on file with the school nurse. 2. Must have filled out a participant information form. 3. Must have filled out an informed consent/assumption of risk form. 4. Must have filled out a parental authorization & waiver of claims form. When is the Room Available for Use? Faculty members who wish to use the room must have turned all paperwork into the high school secretary. They must then fill out a building use form from the business office stating the dates and times they wish to use the room. When faculty signs up, someone in the group must agree to be the supervisor for that time period. Coaches who wish to bring in their teams must communicate with the Athletic Director as to the dates and times they wish to use the room.

3 Fitness Room Rules 1. There is absolutely no food, drink, or gum allowed in the fitness room except for water. 2. Proper workout attire must be worn. This includes shorts or workout pants, t-shirt or sweatshirt, socks, and sneakers. Jewelry must be removed. 3. Do not bring personal belongings into the fitness room. Leave all personal items in your classroom or in a gym locker. We will not be responsible for items taken or lost. 4 Please wipe down equipment after you use it. Bring a towel with you for this purpose. 5. Absolutely no horseplay is allowed. 6. Performing a proper warm-up and stretching before your workout is highly advised. 7. Use all machines properly. 8. Absolutely no muddy or wet sneakers are allowed. 9. Please notify the supervisor if you notice any equipment in need of repair. 10. Always use a spotter when using free weights. 11. Always work with weights that are within your ability. Do not attempt to lift weights that are way too heavy for you. 12. Never drop or slam your weights when you are done. 13. Always put your weights away to their proper location when you are done using them. Do not leave them on the bars, machines, or leaning against things. 14. Use secure collars when using free weights to prevent weights from sliding. 15. Be sure pins are securely in place when using machines. 16. Look around you before you attempt any lift to be sure the area is clear. 17. When using dumbbells, be sure the floor around you is clear of any other weights. 18. There is a 20-minute time limit for cardiovascular equipment when people are waiting. 19. Report any injuries immediately to the supervisor. 20. Violations of these rules may result in loss of room privileges.

4 Confidential Information Controlled Distribution PHYSICIAN S MEDICAL CLEARANCE FORM (name) has requested use of the Mount Morris Central School District s Fitness room. A description of the equipment and exercise activities that are available are described in the attached brochure and explained to the participant in the orientation session. Teachers and/or coaches supervise the District s fitness room. If you know of any medical reason why participation by the applicant would be unwise, please indicate so on this form. If you have any further questions about the facility, its equipment or activities, please call the Mount Morris Central School District s High school Office at PHYSICIAN S REPORT I, (physician s name) give my consent for (members name) to use the Mount Morris School District s Fitness room and participate in its exercise activities. Specific Recommendations: Restrictions: Physician s Signature: Date Physician s Address: Physician s Phone Number:

5 Mount Morris Central School District Fitness Room Participant Information Form Name: (Last) (First) (M.I.) Address: Phone Number: Emergency Contact Name: Emergency Contact Phone Number: Emergency Contact Relationship: Date of Birth: / / (month) (day) (year) Sex (Please circle): Male Female Status (Please circle): Student Faculty/Staff (FOR FITNESS ROOM STAFF ONLY) Attended Orientation Program Physician s Medical Clearance Form Informed Consent/Assumption of Risk Form Participant Information Form Parental Authorization & Waiver of Claims Form (Students Only)

6 Mount Morris Central School District Informed Consent Form Assumption Of Risk Agreement Name: Phone: Address: Emergency Contact: Emergency Contact Phone: Emergency Contact Relationship: As a condition of using the Mt. Morris Central School District s Fitness Room, I acknowledge that I have read this form, fully understand it and agree to its terms and conditions. 1. I hereby acknowledge that I have obtained medical clearance from my physician for the use of the fitness room s equipment and participation in the fitness room exercise activities. The medical clearance form provides proof of this clearance. I further understand that I will be solely responsible for monitoring the manner and intensity of my use of the fitness room s equipment and exercise program, and will do so in a way which will not jeopardize my health, safety or physical well being, or the health, safety or well being of other fitness room users. In particular, I agree that I am solely responsible for complying with any restrictions identified by my physician as to use of the equipment or participation in exercise activities. I further agree that if any circumstances occur which would impact my physician s medical clearance, I will notify the District and my physician of the circumstance. 2. I hereby acknowledge that I have participated in the fitness room orientation program provided by the District. I agree to follow all directions of the fitness room supervisor and acknowledge that failure to follow such directions may result in the termination of my privilege to the use the fitness room. 3. I understand that the supervision of the fitness room provided by the district is general in nature and the fitness room supervisor is not responsible for supervising or monitoring the manner of intensity of my use of the equipment or participation in exercise activities. 4. I hereby acknowledge that my use of the District s fitness room involves risks including possible injuries to bones, muscles, tendons and ligaments, dehydration, abnormal blood pressure, fainting and heart disorders (including heart attacks). Based on the foregoing, I assume all risks associated with my use of the District s fitness room. 5. I hereby release the Mt. Morris Central School District, its Board of Education, in both their corporate and individual capacities its employees and supervisors for all claims (of any nature) relating to my use of the District s fitness room, including, but not limited to claims for personal injury or death, and damage to or loss of personal items. (Users Signature) If user is under the age of 18 the user s parent or guardian must also sign this form as acknowledgement and acceptance of the terms and conditions set forth herein on behalf of the user. (Signature of user s Parent/Guardian) (Date)

7 Parental Authorization & Waiver of Claims Your child has an opportunity to participate in the Mount Morris Central School District s Fitness Room. Prior to your child s use of the Fitness Room, you must provide the District with the following: 1. A fully completed Physician s Medical Clearance form for your child. 2. An Informed Consent form signed by your child and yourself. 3. A completed Participant Information form. 4. This Parental Authorization and Waiver of Claims form. STATEMENT OF AUTHORIZATION As the parent/guardian, I give my consent for my child to use and participate in the activities of the District s Fitness Room. In doing so, I state that I understand and agree to the following: 1. In case of a medical emergency, I grant any Fitness Room supervisor and District employee the right to authorize medical care for my child, if none of the persons named below can be reached. 2. I have obtained a completed Physician s Medical Clearance form for my child. 3. My child has completed the Informed Consent form, which I have acknowledged as parent/guardian of my child, and I agree to the terms and conditions set forth in that Informed Consent form on behalf of my child as his/her parent/guardian. ASSUMPTION OF RISK AND WAIVER OF CLAIMS I acknowledge that potential risks to my child during his/her use of the District s Fitness Room, and participation in its activities, include, but are not limited to: injuries to bones, muscles, skin, tendons and ligaments, dehydration, abnormal blood pressure, fainting and heart disorders (including heart attacks). As a condition of my child s use of the District s fitness Room, and participation in its activities, I assume, on behalf of my child, these and all other risks, which may arise from my child s use of the District s Fitness Room and participation in its activities. I further waive, release and discharge the Mount Morris Central School District, its Board of Education, in both their corporate and individual capacities, its employees, agents and assigns, for all claims (of any nature) relating to my child s use of the District s Fitness Room and participation in its activities, including, but not limited to, claims for personal injury, of death, and damage to or loss of personal equipment. AUTHORIZATION STATEMENT I have read this Parental Authorization and Waiver of Claims form and the Informed Consent form, understand both and have discussed their contents with my child. Based on the foregoing, I fully and voluntarily agree to the terms and conditions set forth in this form and the Informed Consent form as a condition of my child s use of the District s fitness Room and his/her participation in its activities. Student s Name Parent/Guardian Signature Date

8 Fitness Room Responsibilities for the Supervisor Any teacher or coach who is designated as the supervisor for a group of faculty members or students is responsible for the following: 1. Must be sure that all fitness room rules are followed. 2. Must be present in the fitness room the entire time period the group is working out. 3. Must communicate with the Superintendent of Buildings and Grounds as to any damaged or malfunctioning equipment. 4. Must report any injuries to the school nurse and fill out an accident report. 5. Must make any emergency phone calls necessary. All emergency contact forms will be available in a folder in the fitness room. 6. Must be aware that the closest defibulator is in the Athletic Directors office.