Eastchester HS Winter 2017-18 Athletic Participation Form

ALL FIELDS ARE REQUIRED

    Permission to Participate

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    Student Information

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    EMERGENCY MEDICAL TREATMENT INFORMATION

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    Medical History and updates

    The athlete is not cleared to participate until the physical exam date has been verified.

    A record of your child's physical completed within one year of the start date of the sport must be on file in the health office. If it is not on file you may mail one in, hand one in or email it to AthleticApplication@eastchester.k12.ny.us
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    Concussion Management Information

    Please review the following links to required NYS Concussion Management Education Information: NYS Department of Health: http://www.health.ny.gov/prevention/injury_prevention/concussion.htm NYS Department of Education: http://www.p12.nysed.gov/sss/schoolhealth/schoolhealthservices/ConcussionManageGuidelines.pdf
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    ImPACT Testing

    Permission for use of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPact) test. Kindly complete even if you believe your student has been tested. Re-testing of baseline is performed every 2 years. Information of the ImPACT Management Program: http://impacttest.com/about/background
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    Transportation Information

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    Advanced Athletic Placement (formally selection classification)

    A 7th or 8th grader is NOT permitted to participate on a JV or a Varsity team. The only exception is to take the advanced athletic placement test and go through the full procedure. This includes a tanner rating done by a physician, a skill assessment done by the coach, and getting the 85% or higher for your child's age in 4 out of the 5 presidential fitness tests. Please contact the athletic office for more information.

    By printing your name here you agree that you have filled out this form and all of the information above is accurate to the best of your knowledge

    By completing this form you hereby certify that you are the parent/legal guardian of the child listed above. By entering your name and selecting “SUBMIT” you acknowledge that among the information provided about yourself or your child may be considered personal or confidential information, such as your name, your child’s name, medical information, contact information, and other private information. When you submit information to the Eastchester School District “EUFSD”, you understand and agree that EUFSD may store your information in a secure manner on its servers. EUFSD will utilize due diligence and prudent efforts to protect such information as would be considered good practice with regard to electronically stored data. EUFSD appreciates the importance of responsible use of this form and will not share it with any third party without express consent by you. If you choose to provide this form we will use the form only to complete the request specified in the form and to make contact with you with regard to the services on our site for which you have expressed interest.

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    Please hit the submit button ONLY ONCE, then wait for a message confirming your submission before exiting.