INTRAMURAL BASKETBALL ELIGIBILITY CHECK-LIST
REQUIRED PAPERWORK FOR REVIEW AND/OR SIGNATURE: Academic Policies NSCC Application for Admission Release of Information Intramural Questionnaire/ Disclaimer Intramural Participant Agreement
For more information, please contact:
Program Coordinator Jaime Radcliff [email protected] 206.934.3745
Wellness Center Director Carianya Napoli [email protected] 206.934.4591
Athletics Fax Machine: 206.934.7787 ACADEMIC POLICIES FOR STUDENT ATHLETES
I. Basic Premise: Sports and Academics Are Both Important.
A. Program Goals:
1. For Everyone To Get To The Next Level: A 4-Year School
a. Average GPA of 2.0 or higher b. Degree Completion
______Date ______Intramural Student Participant Signature INFORMED ACKNOWLEDGMENTS OF HAZARDS AND RISKS CONNECTED WITH PARTICIPATION IN INTRAMURAL BASKETBALL
THIS FORM MUST BE SIGNED BY THE STUDENT AND PARENT OR LEGAL GUARDIAN IF THE STUDENT IS UNDER 18 YEARS OF AGE
PLEASE READ CAREFULLY AND BE SURE YOU UNDERSTAND BEFORE YOU SIGN
WARNING The purpose of this WARNING is to bring to your attention the existence of potential dangers associated with athletic participation. There is, however, always the risk of other types of injuries or the risk of injury or death resulting form other causes not specified here.
This warning also serves to aid you in making an informed decision as to whether you (or your child or ward) should participate in this athletic activity and, as a condition of such participation, sign the foregoing ACKNOWLEDGEMENT OF HAZARDS AND RISKS CONNECTED WITH PARTICIPATION IN BASKETBALL. In addition, its purpose is to make you aware that as a student-athlete (or as a parent or guardian of a student-athlete), it is your responsibility to learn about and/or ask coaches, physicians, or other knowledgeable persons about any concerns that you might have at any time regarding athletic safety and participation in the College’s basketball program.
Participation in any athletic activity can involve injury of some type to either yourself or fellow student-athletes. Such injury can include direct physical and possibly crippling injury to one’s body. There is also the possibility of suffering emotional distress or psychological injury as a result of witnessing, or actually inflicting injury, to another. The severity of such injury can range from minor cuts, scrapes, bruises, muscle strains, or bone fractures and dislocations to catastrophic injury, such as complete paralysis, or even death. Such injury can impair one’s general physical and mental health and hinder one’s future ability to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life.
Basketball is a sport involving contact. As in all sports, basketball involves the RISKS OF SERIOUS INJURY OR DEATH. Because it is a contact sport, basketball involves the potential risk of serious injury to virtually every part of the human anatomy. Injuries in this sport are common, and occur to all parts of the body, including the head and nick, shoulders, arms, chest, hands and fingers, hips, legs, knees, ankles and feet. These risks of injury in the sport of basketball include the possibility of: Injury to the neck and spinal column or cord, resulting in complete or partial paralysis. Injury to the head, resulting in brain damage. Injury to the body’s major joints, ligaments, muscles, tendons and other internal aspects of the musculoskeletal system. Injury to the body’s nerves, the heart and blood vessels, and other internal or reproductive organs is also possible. Such injuries may cause temporary disability or can result in permanent impairment.
Pre-existing medical conditions, including illness, disease, and prior injuries can be aggravated or cause other injuries while engaged in the sport of basketball. Use of drugs, alcohol or medications can contribute to injury or illness while participation in athletic activity. Some injuries may be caused as a result of poor physical condition and overexertion. Such overexertion can result in injury to muscles, the heart, and to other body parts, resulting in sprains, strains, cardiac or cardiopulmonary arrest, and other medical conditions. Direct blows to the head and chest caused by falling or colliding with other players may cause fatalities in basketball.
Other basketball related injuries can result from: The use of correct or incorrect playing techniques used in tryouts, practices, drills, exercises, warm-ups, games, plays, or other similar undertakings. Injury to the head, or other parts of the body, from contact with other participants, the playing surface, training equipment, and/or other solid objects in and around the basketball court. The improper fit of equipment, defective or worn-out equipment, or from otherwise wearing and/or failing to use basketball equipment or other protective gear. Training room procedures, the use of training equipment, or from administration of first aid or from failing to follow game, training, safety, or other team rules. The use of playing techniques taught or from teaching methods employed by the coaches of this community college. The use of transportation provided or arranged by the college to and from basketball games and other related activities. STUDENT-PARENTAL ACKNOWLEDGEMENT OF HAZARDS AND RISKS
I have read the above WARNING, which is incorporated here by reference, and I understand that basketball is a sport involving the RISK OF INJURY OR DEATH. I also understand that by participating (or by permitting my child or ward to participate) in the basketball program at this community college, I (or my child or ward) am subjecting myself to the possibility of injury or death as outlined in the WARNING above.
CAUTION
BY SIGNING THIS ACKNOWLEDGMENT OF HAZARDS AND RISKS, I ACKNOWELDGE THAT I HAVE READ ITS CONTENTS AND WARNING, THAT I UNDERSTAND ITS CONTENTS AND WARNINGS, AND THAT I AGREE TO ITS TERMS AND CHOOSE TO PARTICIPATE (OR TO PERMIT MY CHILD OR WARD TO PARTICIPATE) IN THE INTRAMURAL SPORT OF BASKETBALL AT THIS COMMUNITY COLLEGE.
Date: ______, 20______Signature of Student
Date: ______, 20______Signature of Parent or Legal Guardian (if Student is Under 18 Years of Age)
WITNESS COLLEGE OFFICIAL
On the day ______of ______, 20______I witnessed the execution of the above.
______Signature of School Official Position
NOTE: If it is not possible for a college official to witness the signature of the parent or guardian where the student is under the age of 18, a notary shall witness the parent’s or guardian’s signature to this acknowledgement of hazards and risks.
Assumption of Risks and Release Form: Basketball NORTH SEATTLE COMMUNITY COLLEGE INTRAMURAL SPORTS PROGRAM ______PARTICIPANT RELEASE OF INFORMATION FORM______
During the course of a student-athlete’s participation in the athletics program at North Seattle Community College, it may become necessary for the athletics program staff to have contact with other agencies and personnel regarding the student-athlete’s progress, personal needs, support services, test results and/or school records.
I agree to allow the staff at North Seattle Community College athletics program to have contact with such personnel including, but not limited to: schools; social service agencies; testing centers; employers; instructors and family members for the purpose of obtaining, providing or exchanging pertinent information which may be used to assist in supporting and monitoring my education program. This includes my authorization for North Seattle Community College athletics program to obtain my grades, course information, GED test scores and other test results as needed by the program.
I also authorize North Seattle Community College athletics staff to provide Northwest Athletics Association of Community Colleges (NWAACC), my demographic information including, but not limited to: name; date of birth; student identification number; last school attended and GPA status for reporting purposes.
I understand that this information will be kept confidential as defined by North Seattle Community College students’ right to privacy guidelines. I also understand that if I wish to withdraw this release of information, it is my responsibility to state so in writing to the North Seattle Community College athletics program staff/program director.
Date: ______
Intramural Student Signature:______
If participant is a minor:
Parent or Legal Guardian Signature: ______STUDENT INFORMATION Personal Information/Questionnaire
Intramural Participant Name______
SID #______Intramural Sport ______
Major______Graduation year______
Email ______Phone Number______
Address______
Male or Female___
Are you employed? Y/N
Are you a Transfer Student? Y/N
Will you be the 1st college graduate in your family? Y/N
Do you have an academic advisor? Y/N
Circle one or more that apply: Drive Bike Walk Bus to NSCC NSCC INTRAMURAL PARTICIPANT TRAVEL AGREEMENT
Attendance at NSCC INTRAMURAL Department sponsored events carries with it the expectation that Intramural participants will conduct themselves as responsible individuals during games, team activities, travel, and during their “free time.” Please review the following agreement. Once reviewed, please sign at the bottom.
While in travel status, I am representing North Seattle Community College, and the Intramural basketball program of the Seattle Community College District.
As a student-athlete, I will honor the NSCC student code of conduct and the NSCC Intramural participant agreement; act responsibly while being respectful of school property.
Consumption of alcohol, drugs or disruptive behavior while in travel status with NSCC is against the student conduct code and will result in disciplinary action.
All students will travel together. Personal cars will not be used unless prior arrangements have been approved.
I understand that once I receive my food allowance for the trip, I am responsible for managing the funds. I further understand that if I, for any reason, lose or spend over my food allowance, that I will be personally responsible for covering my food and beverages for the remainder of the trip. I will not receive any additional money from the Intramural department or North Seattle Community College.
I have read and understand this agreement and will abide by the conduct requirements as outlined in this document.
Signature of Student ______Date ______
Signature of Wellness Director ______Date ______
Signature of Program Coordinator ______Date ______Alcohol and Drug Policy
Intramural Department: As a Student/Faculty member of Seattle Community College, you are required to represent the college in a manner consistent with the SCCD Student Code of Conduct. If alcohol or drug use is witnessed, you will be immediately suspended from the team. ______Alcohol and Drug Policy Seattle Community College District VI recognizes that illicit drugs and alcohol abuse are major social problems which affect the health, safety, and security of individuals and organizations. It is the policy of Seattle Community College District to prohibit the unlawful manufacturing, distributing, possessing, or use of illicit drugs and abuse of alcohol. This policy applies to all employees and students of Seattle Community College District VI, while in or on any owned and/or controlled property of Seattle Community College District VI, or while conducting college business regardless of location. Students who violate this policy will be disciplined up to and including expulsion from the District depending upon the seriousness of the violation. Disciplinary action will be processed by the office of the Vice President of Student Services. Students may also lose federal funding and/or grants for their education. Students who need assistance in dealing with drug/alcohol abuse problems are encouraged to seek help through Student Services. Each campus will establish a drug-free awareness program for students. Nothing stated herein shall preclude Seattle Community College District VI from referring violators of this policy for prosecution as required by law. WAC 132F-136—6- Prohibited Conduct at College Facilities I, ______, have read the above and agree to abide by the policy in its entirety. If I choose to do otherwise, I understand that I risk losing the opportunity to participate and/or retain a scholarship in the basketball program. Violations of the Student Code of Conduct may result in additional disciplinary action.
______
Signature Date