Emergency form, Permission to participate and Concussion/Steroid form

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Coaches and sponsors carry this with them at all events in case the parent/guardian is not able to attend and there is an emergency. You are limited to 1 response per email address. Please list all your children on 1 form. THIS IS FOR HIGH SCHOOL ATHLETES ONLY.

Email *

I verify that I am the parent or guardian of the above listed student and take responsibility for the information given. *

Yes

Student(s) name (If you have more than 1 athlete you can list them both here even if not in their sports season) *

Grade Level *

Freshman

Sophomore

Junior

Senior

Other:

Parent/Guardian name *

Emergency Contact Number *

2nd Emergency Contact Number *

Physician Name *

Physician number *

Specific health Conditions (if any. if none please list n/a) Asthma, heart conditions, etc... *

If you and the physician of choice (as indicated above) can not be reached in case of an emergency and if, in the judgement for the school authorities, immediate medical and/or hospital attention is indicated, do you authorize responsible school authorities to send your child (properly accompanied) to an available hospital or physician? *

Yes

Insurance Information. As the parent/guardian, I waive any claim for liability against the Athletic Co-op, including employees and representatives, and release them from liability in connection with this activity. *

Yes

Insurance Carrier *

Policy Number *

Permission to Participate Form and Handbook acceptance

By checking yes on the upcoming questions you agree to allow your child to participate in the schools activities or sporting teams/clubs. You also agree to the athletic regulations and terms that are printed in the schools handbook which the schools will provide for you upon request. Each student and his or her parent/guardian must read and sign this Agreement to Participate each year before being allowed to participate in interscholastic athletics or intramural athletics.
I acknowledge reading the eligibility rules of any group or association sponsoring any athletic activity in which I want to participate, and I agree to abide by them.
Before I am allowed to participate, I must: (a) provide the School District with a certificate of physical fitness (the Pre-Participation Physical Examination Form from the Illinois High School Association (IHSA), Illinois Elementary School Association (IESA), or Southern Illinois Junior High School Athletic Association (SIJHSAA) serves this purpose), (b) show proof of accident insurance coverage, and (c) complete all forms required by any association sponsoring the interscholastic athletic activity, including when applicable and without limitation, IHSA Sports Medicine Acknowledgment & Consent Form, Acknowledgement and Consent.
I agree to abide by all conduct rules and will behave in a sportsmanlike manner. I agree to follow the coaches’ instructions, playing techniques, and training schedule as well as all safety rules.
I understand that Board policy 7:305, Student Athlete Concussions and Head Injuries, requires, among other things, that a student athlete who exhibits signs, symptoms, or behaviors consistent with a concussion or head injury must be removed from practice or competition at that time and that the student will not be allowed to return to play or practice until he or she has successfully completed return-to-play and return-to-learn protocols, including having been cleared to return by the treating physician licensed to practice medicine in all its branches, physician assistant, treating advanced practice registered nurse, or a certified athletic trainer working under the supervision of a physician.
I am aware that with participation in sports comes the risk of injury, and I understand that the degree of danger and seriousness of risk vary significantly from one sport to another with contact sports carrying the highest risk. I am aware that participating in sports involves travel with the team. I acknowledge and accept the risks inherent in the sport(s) or athletics in which I will be participating and in all travel involved.

As the parent/guardian, I give my son/daughter permission to participate in sports/activities and understand the handbook guidelines. I understand that all sports can involve many risks of injury, and I understand that the degree of danger and seriousness of risk vary significantly from one sport to another with contact sports carrying the higher risk. I am aware that participating in sports involves travel with the team. In consideration of the School District permitting my child/me to participate, I agree to hold the Board, its members, employees, agents, coaches, and volunteers harmless from any and all liability, actions, claims or demands of any kind and nature whatsoever that may arise by or in connection with my/my child’s participation in the sport(s) or athletics. I assume all responsibility and certify that my child is/I am in good physical health and is capable of participation in the above indicated sport or athletics. *

By checking this box, you are signing this form and are responsible for knowing and understanding the handbook guidelines.

As the student/athlete, I understand that I am representing the West Hancock Cooperative system and I agree to conduct myself at all times in accordance with the handbook guidelines. I understand that all sports can involve many risks of injury, and I understand that the degree of danger and seriousness of risk vary significantly from one sport to another with contact sports carrying the higher risk. I am aware that participating in sports involves travel with the team. In consideration of the School District permitting my child/me to participate, I agree to hold the Board, its members, employees, agents, coaches, and volunteers harmless from any and all liability, actions, claims or demands of any kind and nature whatsoever that may arise by or in connection with my/my child’s participation in the sport(s) or athletics. I assume all responsibility and certify that my child is/I am in good physical health and is capable of participation in the above indicated sport or athletics. *

By checking this box, you are signing this form and are responsible for knowing and understanding the handbook guidelines.

IHSA - Concussion Information Sheet. IHSA Performance-enhancing substance testing policy

CONCUSSION INFORMATION SHEET

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussion are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a "ding" or a bump on the head can be serious. You can't see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away.

Symptoms may include one or more of the following:

*Headaches *Amnesia *Pressure in head *Don't feel right *Nausea or vomiting *fatigue or low energy *neck pain *sadness *balance problems or dizziness *nervousness or anxiety *blurred, double, or fuzzy vision *irritability *sensitivity to light or noise *more emotional *feeling sluggish or slowed down *confusion *feeling foggy or groggy *concentration or memory problems (forgetting game plays) *drowsiness *change in sleep patterns *repeating the same question/comment

Signs observed by teammates, parents and coaches include:

*Appears dazed *Vacant facial expression *confused about assignment *forgets play *is unsure of game, score, or opponent * moves clumsily or displays in-coordination *answers questions slowly *slurred speech * shows behavior or personality changes *can't recall events prior to hit *can't recall events after hit * seizures or convulsions *any change in typical behavior or personality *loses consciousness

What can happen if my child keeps on playing with a concussion or returns too soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after the concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that the adolescent or teenage athletes will often fail to report symptoms of injuries. Concussions are no different, as a result, education of administrators, coaches parents and students is the key to student-athlete's safety.

If you think your child has suffered a concussion.
Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. IHSA policy requires to provide their school with written clearance from either a physician licensed to practice medicine in all its branches or a certified athletic trainer working in conjunction with a physician licensed to practice medicine in all its branches prior to returning to play or practice following a concussion or after being removed from an interscholastic contest due to a possible head injury or concussion and not cleared to return to that same contest. In accordance with state law, all IHSA member schools are required to follow this policy. You should always inform your child's coach if you think that your child may have a concussion. Remember its better to miss one game than miss the whole season. And when in doubt, the athlete sits out.
For current and up-to-date information on concussion you can go to:
http://www.cdc.gov/ConcussioninYouthSports/

IHSA PERFORMANCE-ENHANCING SUBSTANCE TESTING POLICY

In 2008, the IHSA Board of Directors established the association's Performance-Enhancing Substance (PES) Testing Program. Any student who participates in an IHSA-approved or sanctioned athletic event is subject to PES testing. A full copy of the testing program and other related resources can be assessed on the IHSA Sports Medicine website. Additionally, links to the PES Policy and the association's Banned Drug classes are listed below, School administrators are able to access the necessary resources used for program implementation in the IHSA Schools Center.

IHSA PES Testing Program
http://www.ihsa.org/documents/sportsMedicine/2015-16/2015-16%20PES%20policy%20final.pdf

IHSA Banned Drug Classes
http://www.ihsa.org/documents/sportsMedicine/2015-16/2015-16%20IHSA%20Banned%20Drugs.pdf

IHSA Steroid Testing Policy Consent to Random testing

As a prerequisite in IHSA athletic activities, we agree that I/our student will not use performance-enhancing substances as defined in the IHSA Performance-Enhancing Substance testing Program Protocol. We have reviewed the policy and understand that I/our student may be asked to submit to testing for the presence of performance-enhancing substances in my/our student's body either during IHSA state series events or during the school day, and I/our student do/does hereby agree to submit to such testing and analysis by a certified laboratory. We further understand and agree that the results of the performance-enhancing substance testing may be provided to certain individuals in my/our student's high school as specified in the IHSA Performance-Enhancing Substance testing Program Protocol which is available on the IHSA website at www.IHSA.org. We understand and agree that the results of the performance-enhancing substance testing will be held confidential to the extent required by law. We understand that failure to provide accurate and truthful information could subject me/our student to penalties as determined by IHSA.
A complete list of the current IHSA Banned Substance Classes can be accessed at:
http://www.ihsa.org/documents/sportsMedicine/2015-16/2015-16%20IHSA%20Banned%20Drugs.pdf

Student/Parent Consent and Acknowledgements. By clicking the box below, we acknowledge we have been provided information regarding concussion and the IHSA Performance-Enhancing Testing Policy. We also acknowledge that we are providing consent to be tested in accordance with the procedures outlined in the IHSA Performance-Enhancing testing Policy. *

Yes

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