Athletic Forms: FAQ

Where else can I get the forms? Forms are available in the main office. Coaches will also give out the forms at their informational meeting which they have weeks to months in advance of the season.

Is my child required to have these forms? All students must have these forms completed, signed by a parent/guardian and physician in order to try-out/practice for athletics. (HCPS policy)

Which forms do I need? The required forms are: Physical Form – signed by a physician Athletic Participation Form FHS-Interscholastic Athlete Policies Form

If your child needs to take any medications, both over the counter and prescription, they will also need the following forms: Medication Policy & Permission Form – allows the coach/nurse to carry the medication and give as directed HCPS Permission for Students to Carry/Self-Administer Medications Form – allows the athlete to carry his/her own emergency medication – for asthma inhalers and/or EpiPen use only

Do I need to make a doctor’s appointment for my child? Your child will need a physical from a licensed physician. Please remember to take the HCPS physical form with you, so that the physician can fill it out and sign it. Only these forms will be accepted. FHS does have a physician who comes to the school one evening before each sports season, including the summer, to perform physicals. The cost is $20.00. These appointments can be scheduled through the school nurse, Dawn Higinbothom ([email protected]).

Does my child need a new physical for every sport season? How long is a physical good for? Physical forms are valid from June 8th through the following school year. They are kept on file at FHS for all three sport seasons. So, a student who plays a fall sport will use the same physical for that school year’s winter and spring seasons.

What if I do not have insurance? HCPS has student accident insurance plans available at a reduced price. Forms are available in the main office and from the athletic director.

When are the forms due? Forms are due, at the latest, the first day of try-outs. However, many coaches require participation forms to be turned in prior to the first try-out/practice day. Please contact the head coach of the sport your child is trying out for to get further information.

Who can I contact for more information about Fallston High School Athletics? For general questions regarding FHS athletics, please contact the Athletic Director: Mr. Dave Cesky at 410-638-4032 or [email protected]

Pre-Participation Physical Evaluation (This page to be completed by physician/nurse practitioner/physician assistant)

PHYSICAL EXAMINATION DATE OF EXAM ______NAME ______DATE OF BIRTH ______HEIGHT______WEIGHT ______% BODY FAT (optional) ______PULSE ______BP ______VISION R 20/ ______L 20/ ______CORRECTED? Y _____ N _____ PUPILS: EQUAL ______UNEQUAL ______

NORMAL ABNORMAL FINDING INITIALS * MEDICAL Appearance ______Eyes/Ears/Nose/Throat ______Lymph nodes ______Heart ______Pulses ______Lungs ______Abdomen ______Genitalia (males only) ______Skin ______MUSCULOSKELETAL Neck ______Back ______Shoulder/Arm ______Elbow/Forearm ______Wrist/Hand ______Hip/Thigh ______Knee ______Leg/Ankle ______Foot ______

*Station-based examination only CLEARANCE

q Cleared

q Cleared after completing evaluation/rehabilitation for: ______

q Not cleared for [Sport(s)]:______Reason: ______

Recommendation: ______

Name of physician/nurse practitioner/physician assistant ______Date: ______(PRINT OR TYPE) Address: ______Phone: ______Signature of physician/nurse practitioner/physician assistant ______

PHYSICIANS STAMP:

Endorsed by the MPSSAA © 1997 American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine Pre-Participation Physical Evaluation HISTORY This page to be completed by student and parent/guardian

Name ______Sex ______Age ______Date of Birth ______Grade _____ School ______Sport(s) ______Address ______Personal physician ______In case of emergency, contact Name ______Relationship ______Phone (H) ______(W) ______

Explain “Yes” answers below. Circle questions if you don’t know the answers.

YES NO YES NO 1. Have you had a medical illness or injury since qq 10. Do you use any special protective or corrective qq your last check up or sports physical? equipment or devices that aren’t usually used for your sport Do you have an ongoing or chronic illness? qq or position (for example, knee brace, special neck roll, foot orthotics, retainer on your teeth, hearing aid)? 2. Have you ever been hospitalized overnight? qq 11. Have you had any problems with your eyes or vision? qq Have you ever had surgery? qq Do you wear glasses, contacts, or protective eyewear? qq 3. Are you currently taking any prescription or qq nonprescription (over-the-counter) medications or 12. Have you ever had a sprain, strain, or swelling after injury? qq pills or using an inhaler? Have you broken or fractured any bone, or dislocated qq Have you ever taken any supplements or vitamins qq any joints? to help you gain or lose weight or improve your Have you had any other problems with pain or swelling qq performance? in muscles, tendons, bones, or joints? 4. Do you have any allergies (for example, to pollen, qq If yes, check appropriate box and explain below. medicine, food, or stinging insects)? q Head q Upper arm q Hand q Knee Have you ever had a rash or hives develop during qq q Back q Elbow q Finger q Shin/calf or after exercise? q Chest q Forearm q Hip q Ankle 5. Have you ever passed out during or after exercise? qq q Shoulder q Wrist q Thigh q Foot Have you ever been dizzy during or after exercise? qq 13. Do you want to weigh more or less than you do now? qq Have you ever had chest pain during or after exercise? qq Do you lose weight regularly to meet weight requirements qq for your sport? Do you get tired more quickly than your friends do qq during exercise? 14. Do you feel stressed out? qq Have you ever had racing of your heart or skipped qq 15. Record the dates of your most recent immunizations (shots) for: heartbeats? Tetanus ______Measles ______Have you had high blood pressure or high cholesterol? qq Hepatitis B ______Chickenpox ______Have you ever been told you have a heart murmur? qq Has any family member or relative died of heart qq FEMALES ONLY problems or of sudden death before age 50? 16. When was your first menstrual period? ______Have you had a severe viral infection (for example, qq When was your most recent menstrual period? ______myocarditis or mononucleosis) within the last month? How much time do you usually have from the start of one period to the Has a physician ever denied or restricted your qq start of another? ______participation in sports for any heart problems? How many periods have you had in the last year? ______6. Do you have any current skin problems (for example, qq What was the longest time between periods in itching, rashes, acne, warts, fungus, or blisters)? the last year? ______7. Have you ever had a head injury or concussion? qq qq Have you ever been knocked out, become unconscious, Explain “Yes” answers here: ______or lost your memory? ______Have you ever had a seizure? qq ______Do you have frequent or severe headaches? qq ______Have you ever had numbness or tingling in your arms, qq hands, legs, or feet? ______Have you ever had a stinger, burner, or pinched nerve? qq ______8. Have you ever become ill from exercising in the heat? qq ______9. Do you cough, wheeze, or have trouble breathing qq ______during or after activity? ______qq Do you have asthma? ______Do you have seasonal allergies that require medical qq ______treatment?

We hereby state that, to the best of our knowledge, our answers to the above questions are complete and correct. Signature of athlete ______Signature of parent/guardian ______Date ______

© 1997 American Academy of Family Physicians, American Academy of Pediatrics, American Medical Society for Sports Medicine, American Orthopedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine

HARFORD COUNTY PUBLIC SCHOOLS INTERSCHOLASTIC ATHLETICS

ATHLETIC PARTICIPATION FORM

______(Sport)

STUDENT NAME:______of ______High School

ADDRESS:______HOME PHONE:______

CITY:______, MD. ZIP______CELL PHONE: ______CELL PHONE:______TO THE PARENT OR GUARDIAN:

It is the goal of the Harford County Public Schools Interscholastic Athletic Program to provide a safe and supportive environment for all students. We believe athletes need to develop skills that will teach good sportsmanship, self- discipline, and relationship skills. Toward that end, coaches, students, and parents should be aware of school, county and state policies and procedures that support these goals. Students who have elected to participate in the athletic program will be required to practice and participate in scheduled contests after regular school hours and possibly on non- school days. The supervision of practices, games and travel will be provided by HCPS and the school.

1. General Guidelines for Participation A. A physical examination by qualified medical personnel submitted on the HCPS physical form. This form may be found at http://www.hcps.org/departments/docs/curriculum/athletics/Athletic_Physical_Form.pdf This exam shall be valid from June 8 through the following June 7. B. Medical Insurance covering the sport in which the student wishes to participate. C. The athlete and the parent/guardian are financially responsible for any and all athletic equipment issued to the participant if not returned to the school. D. Students must meet all eligibility requirements as set forth in the MPSSAA Eligibility code 13A.06.03. http://www.mpssaa.org/assets/publications/2008-09%20Handbook%20Website.pdf

2. Eligibility Requirements and Harford County Public School Policies A. Academic Eligibility: All students must comply with the HCPS Board of Education Policy #02.0010, Students - Participation in Extracurricular Activity Policy. http://www.hcps.org/BOE/PoliciesProcedures/boardpolicymanual.aspx See 02 Students 0010 B. Alcohol and Controlled Dangerous Substances: All students must abide by Board of Education Policy #02.0013 with regard to Student Possession, Use, or Transference of Controlled Dangerous Substances, Medicines, or Alcohol. Students in violation of this policy will be subject to disciplinary consequences. http://www.hcps.org/BOE/PoliciesProcedures/boardpolicymanual.aspx See 02 Students 0013 C. All participants are subject to Board of Education Policy 02.0007 Discipline Policies. This policy includes student discipline pertaining to sexual harassment, threats, misconduct, and disruptive behavior. http://www.hcps.org/BOE/PoliciesProcedures/boardpolicymanual.aspx See 02 Students 0007 D. All participants are subject to the high school rules, athletic rules, and team rules in each high school.

3. Insurance Students must have health insurance coverage in effect on the first day of practice in order to participate in interscholastic athletics. If your student does not have health insurance, reasonably priced policies may be purchased through an independent carrier provided by the school system. Information on the purchase of school health/accident insurance may be obtained at your school office.

MY SIGNATURE VERIFIES THAT MY SON/DAUGHTER IS COVERED BY HEALTH INSURANCE.

Health Insurance Company: ______Policy or Group Number:______

MY SIGNATURE VERIFIES THAT I GIVE MY SON/DAUGHTER PERMISSION TO PARTICIPATE

Parent/Guardian Signature: ______Date:______

4. Residency All participants in Interscholastic Athletics must abide by Board of Education Policies #20.0035, Assignment To Schools in Attendance Area and #02.0003, Admission Policy. http://www.hcps.org/BOE/PoliciesProcedures/boardpolicymanual.aspx See 20 Assignment To Schools in Attendance Area 0035 See 02 Admission Policy 0003

MY SIGNATURE VERIFIES THAT:

My child resides within the attendance area of: ______High School

My child attends: ______High School

Please note: Students attending a school outside of their residential attendance area may ONLY DO SO WITH SPECIAL PERMISSION of the Office of Student Services, or the Magnet Coordinator of Aberdeen High School, Edgewood High School, or Harford Technical High School. Any student in violation of the Board of Education Attendance Area policy is subject to loss of athletic eligibility for a determined period of time, ineligibility in a specific sport for the forthcoming year, or penalties as deemed justified in any specific case. Penalties may also be imposed on the violating athlete’s team and school.

MY SIGNATURE VERIFIES THAT:

1. I will provide a statement of my utility bill dated within thirty days of the sport season. 2. I will notify the school immediately if there is a change in my place of residence. 3. I have read all of the above statements and hereby give my written consent.

Parent Signature:______Date:______

Student Signature:______Date:______

PE-1020 Rev.02-01-09 Form 17-09430 Fallston High School – Interscholastic Athlete Policies

The following set of Athletic Rules have been developed by the coaching staff of Fallston High School and in accordance with the Rules and Regulations of Interscholastic Athletics in Harford County Public Schools. These statements are used as a minimum set of training rules for all sports at Fallston High School. If an individual coach wishes to expand upon these policies for a particular sport, a copy must be submitted to the Athletic Director for his review and approval.

1. Confirmed use, possession, or distribution of tobacco, alcohol or illegal drugs, either on campus or in the community, will result in expulsion from the team for the remainder of the season.

2. Student-athletes at Fallston High School are expected to maintain academic performance in accordance with the standards set by the Harford County Board of Education’s “Participation in Extracurricular Activities-Eligibility Rules.” Student-athletes should remember that participation on an athletic team is a privilege and is secondary to academic performance. Student-athletes must complete the sports season in order to earn their athletic letter.

3. Student-athletes at Fallston high School are expected to display a respect toward the administration, faculty members, coaches, parents and their peers. They are also expected to respect and adhere to school rules and regulations. Serious and or repeated violations of the classroom or school rules may result in suspension or removal of eligibility.

4. Student-athletes at Fallston High School are to remember that their conduct in School and in the community directly reflects on the school, their parents, the athletic program, and respective teams.

5. Student-athlete are responsible for the care and development of their teammates. Therefore, any form of hazing or harassment would be unacceptable and could lead to suspension or removal of eligibility.

6. On each day of a season (practice or contest) student-athletes at Fallston High School shall attend school the entire day except for doctors excuses, and in extenuating circumstances which will solely be determined by the administration and athletic director.

The Athletic Policies are for the benefit of student-athletes at Fallston High School. They are intended to build character, encourage physical excellence, and foster respect for the positive qualities of athletics.

I have read, understand, and have been given a copy of the Fallston High School Athletic Policies and Code of Conduct.

______Date (Signature)

______Date (Signature of Parent/Guardian)