Parent and Participant Disclosure Form
Approved Dec. 9th 2013, Revised Fall 2014
Students who become involved in clubs and activities generally get better grades and are less likely to drop out. We encourage everyone to take part in life at Libby Middle High School. These activities are considered an extension of the school day, so all school rules are in effect and will be enforced. We are very proud of our school and the fine record and the accomplishments of our students. Our participants will be helping us build on these fine traditions, so welcome to Logger Territory. Students who choose to participate in activities will have greater expectations placed on them than the average student who attends LMHS.
Our school’s programs exist to provide activities through which students may develop mentally, physically, and socially in a competitive climate. Unselfish participation and team effort is stressed to promote individual growth in attitude, confidence and self-discipline. A winning attitude is essential for a successful program, but the reward for superior effort is of greater importance than winning itself. Negative attitude, exemplified in apathy, poor sportsmanship, and blame finding, have no place in the school’s activities program. By adherence to these standards, we b
elieve that the activities’ program can be a unifying force in the school and the community. The following rules and regulations have been developed in conjunction with existing school disciplinary rules and procedures. Participants must realize that they may be subject to both extracurricular activity discipline and, when applicable, school district rules.
Code of Conduct for Participants involved in all Activities
Because illegal activity is illegal on any date of the year, and poor conduct by participants should not occur any time during the year, Libby Schools can not condone or appear to be indifferent towards these behaviors at any time. But the fact of the matter is that we are only able to govern such behaviors during the school year, when students are under our supervisory care. All of the rules that are outlined in this policy will be strictly enforced (for all participants in or out of season) from the first day of practice in August until the last day of school. The following headings are considered unacceptable behavior for anyone participating in all activities and are to be enforced by the coaches/sponsors, local law enforcement and the administration. These rules are enforced for the duration of the school year and are cumulative for the participant’s high school career. Appeals are to be made to the appropriate administrator who will designate an appeal board made up of coaches from other sports, a school board representative and administration.
I. Cyber Imaging/Electronic Devises Guidelines
Any identifiable image, photo, or video that implies a participant has been in the possession, or presence of, or portrays the actual use of alcohol or drugs, or out of character behavior/crime, shall be considered confirmation of a violation of the code of conduct. If there is no way to establish a time frame when or where an image was taken, it shall be the responsibility of the participant to provide proof of time and place when called upon to do so.
Furthermore, any Libby participant who uses an electronic device to terrify, intimidate, threaten, harass, or offend another person or who uses obscene, lewd, or profane language; suggests a lewd or lascivious act, or threatens to inflict injury or physical harm to a person or the property of a person will have violated the code of conduct. These actions are a violation of Montana Code Annotated 45-8-213 and will be turned over to the school administration.
In addition to the possible penalties served by law enforcement, the participant will serve, as a minimum, a level two consequence. Depending on the severity of the infraction a participant may also be rendered a level three consequence as determined by LMHS administration.
II. Alcohol, Tobacco, or Illegal Substances Use or Possession
Note: The policy recognizes specific doctors prescribed medications based upon an individual’s needs.
If a participant uses or is in the presence of alcoholic beverages OR illegal substances he/she is in violation of the Logger Code of Conduct. Participants cannot remain at a gathering where illegal drugs or alcohol are present. If a participant shows up to a party and discovers these activities occurring, he/she is expected to leave immediately. If he/she remains at the gathering, the consequences will be enforced. The use of chewing tobacco and smoking is illegal for most participants and will be treated as such for all students in this policy (even if you are 18 years old). It is not a healthy choice and does not represent the Life of a Logger. Though being in the presence of those using tobacco or smoking is not advised, it does not carry the same penalties as being at a party. These are level 3 offenses (see consequence table).
III. Other Behavior Not Specified
Any conduct not specified in this disclosure form as determined by a consensus of sponsors/coaches and administrators will warrant consequences. Consequences for these infractions will vary depending on the severity of the act, (minor, major, or severe). See the consequence table.
IV. Season Length/ Athletic Career
A particular activity season begins with the first practice as defined by MHSA guidelines. The season does not end until all equipment is returned and the participant’s other obligations are fulfilled. A participant must complete the season in good standing in order to be eligible for honors and awards given for that activity. A student’s athletic career starts the first day he/she chooses to go out for a sport. The Life of a Logger rules will be strictly enforced from that day forward. Any previous code of conduct violations prior to participating will be dealt with on a case by case basis administratively. The administration has the right to create a probationary behavioral contract for any participant that might have exhibited conduct unbecoming during their high school years while not participating in sports. This may also apply to a transfer student who has experienced the same conditions.
Off Season “Opt In” pledge (Summer Program) The summer months must be supervised by the student participant’s guardians. For the Life of a Logger to be effective, all parties must commit to helping keep our participants on the right path, which means living a clean and positive lifestyle. Since the school policy does not cover the summertime, the students may choose to “opt in” to the Life of a Logger by pledging to abstain from any illegal activities outlined in the code of conduct during the summer and commit to working to improve their skills by actively participating in the GREAT Sweat Out conditioning program and attending summer camps. Their guardians would be responsible for helping to monitor the participant’s activities and willing to turn him/her over to the school’s administration if any violation occurs.
V. Family Night
The school district is committed to minimizing conflicts with family activities. Wednesday night is acknowledged as Family Night. Libby High School will make every effort to restrict school contests, activity competition, band concerts, etcetera on this evening. Currently athletic practices are scheduled on a rotating basis on Wednesday night due to limited gym space and to minimize any conflict with family night activities. Coaches are most willing to cooperate with participants in meeting their individual obligations. You are encouraged to discuss personal practice conflicts with your coach, with the understanding that missing practice for family obligations on Wednesday nights will not be held against players by the coaches.
VI. Attendance Issues
Participants must attend school the entire day of any activity or practice in which they plan to participate. If a participant is too sick to be in school, they should not attend practice that day! If a parent/guardian needs to take a student out of school on a practice day, they should excuse the absence through the front office. The participant should then tell his/her coach about missing school and give the reason why. If a student comes to school late due to illness and wishes to practice, he/she must clear it with administration as soon as they get to school before they will be allowed to practice. If a student misses class on the day of an event or the day the team is leaving for an event they will not participate that day. If a student must miss school on game day, the Parents/Guardian must call the administration PRIOR to the absence to get it excused. Please contact Mr. Germany at 293-1913 if last minute situations arise.
At no time will participants be released to travel with anyone other than parent/guardian, or other parent of participants as designated without written permission. All requests by must be approved by the coach/sponsor, and in some cases administration, prior to the departure. No student vehicles and/or student drivers will be allowed on school sponsored activities.
VIII. Academic Eligibility
According to the National Collegiate Athletic Association, the likelihood of a high school student going on to participate in college or professionally is minutely remote, (only 2 % go on to college athletics). It is much more likely that student-athletes will have a career outside of athletics. Therefore, it is expected that Libby student-athletes excel in the classroom first before excelling on the field, court, or performance arena. A student athlete is expected to pass all classes every semester, but semester eligibility is guided by the MHSA rules concerning eligibility of students. MHSA rules are available at LMHS (or online at mhsa.org.,) but in simple terms it states that all student athletes must pass 20 hours of instructional studies (pass 4 of 7 classes) to be eligible for activities for the next semester.
Students who commit to being a participant in the activities offered by Libby Middle High School will also be required to maintain a 2.0 WEEKLY GPA
Procedure for monitoring grades:
1- Teachers will enter their weekly grades by the end of the day on Friday’s and checked every 2 weeks.
2- On Mondays, those students whose GPA is below a 2.0 will be notified that they are starting their 2 week academic probationary period. While on probation, they will be responsible for turning in an updated grade sheet to the office to show that they are making progress with their grades.
5- After the two week probationary period, students will be ineligible on a week to week basis. The week starts on Monday, which means that they they will be eligible (or ineligible) the following Monday.
Please Note: Although it is the student participant’s responsibility to improve his/her grade to a satisfactory level, interventions may be implemented for those students who continue to struggle to maintain a 2.0 GPA due to academic deficiencies. They MAY be placed on an individual academic plan such as an “Effort Grade Contract” for his/her classes that will outline specific expectations to adhere to, which will allow him/her to remain eligible. Coaches and sponsors may also develop additional rules governing participants that are sport specific.
CONSEQUENCES/ Penalty Points
Level 1 Violations: (1 point per violation)
Minor degree of conduct unbecoming a Logger. Some examples of these offenses are: numerous refocuses, Red Cards, office referrals, low degree bullying/harassment, minor insubordination or defiance, and/or inappropriate comments/actions, etc. Most of these issues are outlined in the school’s handbook and will be tracked through our school’s disciplinary system.
Consequences for these infractions will vary sport to sport and will be handled by the coaches.
Level 2 Violations: (3 points per violation)
Major degree of conduct unbecoming a Logger. Participants will move to a Level 2 by accumulating 3 or more Level 1 points or by engaging in actions that are considered major offenses. Some examples of these offenses are: high degree bullying/harassment, assault or mutual fighting, major insubordination or defiance, etc.
Consequences for Level 2 violations could include not starting a game, or by sitting out a minimum of ½ of a game or 1 match, but may vary depending upon the sport and the severity of the offense(s).
Level 3 Violations: (7 points per violation)
Severe degree of conduct unbecoming a Logger. Participants will move to a level 3 by accumulating 7 or more points under the other levels or by engaging in any illegal activities: (drinking/drugs, smoking, theft, etc.). Any extreme conduct that endangers a participant or his/her peers OR is deemed to be excessive by the administration may result in an immediate termination of an athlete’s career.
Consequences for Level 3 violations will start with a suspension from that activity for a minimum of five (5) calendar days up to period of fifteen (15) calendar days, with a minimum of one competition or performance. This is excluding summer vacation (summer vacation ends with the beginning practices for fall activities). The days suspended will be sport specific due to varying lengths of season and number of total competitions. The days of suspension will carry over from season to season if necessary. This suspension will begin the day the participant reports the infraction to his/her coach or the administration. It will include competition and travel with activities, but they will be allowed to practice with the team or group while suspended.
Second Violation (or 14 accumulated points):
Suspension from all activities for a minimum of thirty (30) calendar days up to period of forty-five (45) calendar days excluding summer vacation (summer vacation ends with the beginning practices for all activities). This suspension will include competition and travel with activities. The student may be allowed to practice with the team or group depending on length of season remaining. The suspension days will carry over from season to season if necessary. If the violation is alcohol or drug related, they must enroll and successfully complete an approved drug/alcohol education program. A favorable recommendation from the program coordinator is necessary before the student is allowed to return to participate in the activities programs. The cost of enrollment in this program is the responsibility of the parent/guardian.
Third Violation (or 21 accumulated points):
Expulsion from from all activities at LMHS for the remainder of their middle/high school career.
It is important to remember that all Logger activity participants are human and make mistakes. Our goal is to help guide the participants involved in Logger activities through the mistakes they may make during their high school years by allowing them to turn the negative decisions they make in life into positive life long learning experiences. Restorative Justice, is a procedure whereby participants can erase the “Penalty Points” that they have incurred due to code of conduct violations. With the participant's head coach’s approval they will write a formal proposal that outlines the manner in which they will choose to restore their name and present it to the Life of a Logger appeal board made up of coaches of other activities, administration, and a school board representative. All level 1 and 2 penalty points may be reduced or erased through Restorative Justice, but Level 3-“Severe” infractions cannot be erased from a student's record for the duration of their high school career, (for example if an athlete get’s a MIP their Freshman year and then again their Junior year, it would constitute a second “severe” violation and result in a 30 to 45 day suspension from activities).
The proposal should outline the lesson learned from his/her experience, and what actions he/she will complete to restore their name. The review board will determine if a reduction in suspension is warranted and/or how many points will be subtracted from the participant’s record. After verification that their commitments have been met, they will lose any points they have accumulated. The Logger Review Board’s decision will be enforced the the LMHS administration. The only appeal of their decision is to the Superintendent and eventually the Board of Trustees.
Here is an outline of possible ways participants can earn back points:
As a member of the ______________________ team, I am dedicated to more than the x’s and o’s of competition. I know that less than 2% high school athletes go on to play team sports at the college level. Therefore, I understand that high school athletics provide students a unique opportunity for the development of not only physical conditioning and athletic skill, but also character traits essential for success in life. Recognizing my role as a role model for students and the community , for this season I commit to:
1- Exemplify the highest moral character as a role model for younger students.
2- Establish a realistic team and individual goals for each season and communicate that to my coaches.
3- Encourage and assist team members to set personal goals to achieve their highest academic potential.
4- Support the positive values of abstaining from the use of alcohol, tobacco and other drugs (performance degrading substances) with my teammates throughout the school year and summer.
5- Help promote a challenging and encouraging environment for practice and competition.
6- Respect the integrity and judgment of the game officials.
7- Teach and abide by the rules of the game in letter and in spirit.
8- Build and maintain ethical relationships with other coaches and administrators.
9- Strive for excellence by improving my playing skills and techniques by continued practice throughout the year.
10- Promote personal fitness and good nutrition in my daily diet and sleep habits.
11- Be modest in victory and gracious in defeat.
Sign and date on the Logger Code of Conduct and Permission Form
Parent’s Commitment Form
I understand that as a parent I play a vital role in the development of my child’s ability and character, and therefore in the success of the School’s Athletic Program. As a parent of a member of the _______________________ team, I recognizing this role, I therefore commit to:
1- Be a positive role model so that through my own actions I can help to make sure that my child has the best athletic experience possible.
2- Be a “team fan” not a “my kid” fan.
3- Weigh what my child says in any controversy, since it is normal for youth to tend to slant the truth to their advantage
4- Show respect for opposing players, coaches, spectators and support groups.
5- Be respectful of all official’s decisions.
6- Not instruct my child before or after a game, because it may conflict with the coach's plans and strategies.
7- Praise & encourage athletes in their attempt to improve themselves as students, as athletes and as people.
8- Gain an understanding and appreciation for the rules of the game.
9- Recognize and show appreciation for an outstanding play by either team.
10- Help my child learn that success is experienced in the development of his/her skills, and that he/she can feel positive and their skill development during the season, regardless of the team’s record.
11-Take time to talk with coaches in an appropriate manner, including proper time and place, if I have a concern. I will respect the coach by following the designated chain of command.
12- Support the alcohol, tobacco and other drug free policies of our School by refraining from the use of any such substances during athletic contests. I will also support my child and hold him/her accountable for their commitment to non-use of substances as outlined in the Code by not hosting parties that have alcohol or drugs or allowing my to be at a party with alcohol or drugs.
Sign and date on the Logger Code of Conduct and Permission Form
As the coach of the (boys or girls) ______________________________ team, I am dedicated to more than the X's and O's of competition. I know that less than 2% of high school athletes go on to play team sports at the college level. Therefore, I understand that high school athletics provide students a unique opportunity for the development of not only physical conditioning and athletic skill, but also character traits essential for success in life. Recognizing my role as educator, leader and role model for students, for the next season I commit to:
1- Exemplify the highest moral character as a role model for young people.
2- Recognize the individual worth and reinforce the self-image of each team member.
3- Establish a realistic team goal or vision for each season and communicate that to the athletes and parents.
4- Encourage and assist team members to set personal goals to achieve their highest academic potential.
5- Create a set of training rules for athletes that reflect the positive values of abstaining from the use of alcohol, tobacco and other drugs (performance degrading substances).
6- Strive to develop the qualities of competence, character, civility and citizenship in each team member, as outlined in the athletic policy/code.
7- Provide a safe, challenging and encouraging environment for practice and competition.
8- Gain an awareness of the importance of prevention, care and treatment of athletic injuries.
9-Respect the integrity and judgment of the game officials.
10- Teach and abide by the rules of the game in letter and in spirit.
11- Build and maintain ethical relationships with other coaches and administrators.
12- Strive for excellence in coaching skills and techniques through professional improvement.
13- Promote personal fitness and good nutrition.
14- Be modest in victory and gracious in defeat.
15- Refrain from use of alcohol, tobacco or other drugs before, during, or immediately after practices and games or until my supervisory duties are completed.
Sign and date on the Logger Coach’s Code of Conduct Form
Concussions in Sports - MHSA Fact Sheet for PARENTS
WHAT IS A CONCUSSION? - A concussion is a brain injury. Concussions are caused by a bump or blow to the head. Even a “ding”, “getting your bell rung” or what seems to be a mild bump or blow to the head can be serious. You can’t see a concussion. Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury. If your child reports any symptoms of concussion, or if you notice the symptoms yourself, seek medical attention right away.
WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION? - If your child has experienced a bump or blow to the head during a game or practice, look for any of the following signs and symptoms of a concussion:
- Appears dazed or stunned
- is confused about assignment or position
- Forgets instructions
- is unsure of game, score or opponent
- moves clumsily and answers questions slowly
- loses consciousness (even briefly)
- can’t recall events prior to the hit or fall
- can’t recall events after the hit or fall
SYMPTOMS REPORTED BY THE ATHLETE
- Headache or “pressure” in the head
- Balance problems or dizziness
- Nausea or vomiting
- Double vision or blurry vision
- sensitivity to light
- sensitivity to noise
- Feeling sluggish, hazy, foggy, or groggy
- Has concentration or memory problems
- Does not “feel right”
HOW CAN YOU HELP YOUR CHILD PREVENT A CONCUSSION?
Every sport is different, but there are steps your children can take to protect themselves from concussion.
- Ensure that they follow their coach’s rules for safety and the rules of the sport
- Encourage them to practice good sportsmanship at all times
- Make sure they wear the right protective equipment for their activity (such as helmets, padding, shin guards, and eye and mouth guards) Protective equipment should fit properly, be well maintained, and be worn consistently and correctly
- learn the sign and symptoms of a concussion
WHAT SHOULD YOU DO IF YOU THINK YOUR CHILD HAS A CONCUSSION?
1- Seek medical attention immediately. A healthcare professional will be able to decide how serious the concussion is and when it is safe for your child to return to sports and the level of their activity.
2- Keep your child out of play. Concussions take time to heal. Don’t let your child return to play until a health care professional say its OK. Children who return to play too soon (while the brain is still healing) risk a greater chance of having a second concussion. Second or later concussions can be very serious. They can cause permanent brain damage, affecting your child for a lifetime.
3- Tell your child’s coach about any recent concussions. Coaches should know if your child has had a recent concussion in ANY sport. Your child’s coach may not know about a concussion your child received in another sport or activity unless you tell the coach.
MHSA STUDENT ATHLETE & PARENT LEGAL GUARDIAN CONCUSSION STATEMENT
Because of the passage of the Dylan Steiger’s Protection of Youth Athletes Act, schools are required to distribute information sheets for the purpose of informing and educating student athletes and their parents of the nature and risk of concussion and head injury to student athletes. including the risks of continuing to play after concussion or head injury. Montana law requires that each year, before beginning practice for an organized activity, a student athlete , and both parents must sign and return a form acknowledging receipt of the information to an official designated by the school or school district prior to the student athlete’s participation during the designated school year. The law further states that a student athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from play at the time of the injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider
We have read the MHSA fact sheets “Concussion in Sports” and discussed this information with coaches and other school personnel.
Student Athlete Name ________________________________________ date ______________
Parent/Legal Guardian Name(s) ________________________________ date ______________
After reading the information sheets and having discussions with coaches and school personnel I can initial the following statements about concussions as they apply to me
_______ A concussion is a brain injury, which should be reported to my parents, ________
my coaches, or a medical professional if one is available.
_______ A concussion can affect the ability to perform everyday activities such as ________
the ability to think, balance, and classroom performance
_______ A concussion can not be “seen”. Some symptoms might be present right ________
away. Other symptoms can show up hours or days after an injury.
_______ I will tell parents, my coach, and/or a medical professional about my N/A
injuries and illnesses.
_______ If I think a teammate has a concussion, I should tell my coaches, parents N/A
or licensed healthcare professional about the concussion.
_______ I will not return to play in a game or practice if a hit to my head or body N/A
causes any concussion related symptoms
_______ I will or my child will need written permission from a licensed health care ________
professional to return to play or practice after a concussion.
_______ After a concussion, the brain needs time to heal. I understand that I am or ________
my child is much more likely to have another concussion or more serious
brain injury if return to play or practice occurs before symptoms go away
_______ Sometimes, repeat concussion can cause serious and long lasting ________
_______ I have read the concussion symptoms on the Concussion Fact Sheet ________
LOGGER CODE OF CONDUCT AND PERMISSION FORM
Participants Name ___________________________________________________________
Last Name First Name
Code of Conduct Policy
We acknowledge that we have received, read, discussed, and understand the Logger Code of Conduct Policy which any participant on a Libby Middle/High School athletic/extracurricular team is asked to abide by. We also acknowledge that we have read and agreed to the terms of the “Athlete’s Commitment” as explained to me by coaches and school personnel.
Athlete and Date Parent/Guardian and Date
We have been warned and are aware that there is a risk of injury as a result of participating in a Middle/High School sport or activity. We have been warned and are aware that the injury may be severe but not limited to death, fractures, brain injuries, paralysis, neck or spinal injuries, damage to virtually all internal organs, serious injury to ligaments, tendons, and other aspects of the muscular system, but nevertheless we want to participate in Libby Middle/High School athletics and extracurricular activities. We also acknowledge that we have been given information specific to the signs and symptoms of concussions (as required by state law) by school personnel.
Athlete and Date Parent/Guardian and Date
Parent/Guardian Permission to Travel
I, the parent/Guardian of ___________________________ give my approval for his/her participation in any of the organized and supervised extracurricular activities and programs conducted by the Libby Public School under the following conditions:
A- If chosen for a squad/team which is to make an out of town trip, he/she is to travel under the coach’s direction and authority from the time of departure until the return to Libby.
B- He/She has permission to participate in any supervise sport or activity except: (list exception) __________________________
C- The coach, or any member of the school staff, or any member of the Board of Trustees will not be held liable or responsible in case of an accident incurred during practice, games or trips, supervised by Libby Public Schools.
Parent/Guardian Signature and Date
Please check one of the following:
___ A – I will purchase school insurance and will assume the responsibility of securing the policy and making payments to the company.
___ B - We have other insurance which will cover the individual
___ C – We do not choose to carry insurance and will assume full responsibility.
Parent/Guardian Signature and Date
Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray, examinations, and immunizations for the above named participant. In the event of serious illness, the need for major surgery, or significant accidental injury, I understand that an attempt will be made by the attending physician to contact me in the most expeditious way possible. If said physician is not able to communicate with me the treatment necessary for the best interest of the above named participant may be given. In the event that an emergency arises during a practice session and will be made to contact the parents/guardians as soon as possible.
Parent/Guardian Signature and Date
Phone numbers where parent/guardian can be reached:
Work ___________________________________ Family Physician ___________________________________
Home ___________________________________ Insurance Company _________________________________
Cell ____________________________________ Insurance ID _______________________________________