Poolesville High School Athletics Parent / Student Handbook

2015-2016

REQUIRED PAPERWORK TO PARTICIPATE IN INTERSCHOLASTIC ATHLETICS

The Poolesville Scholar-Athlete:

“First, a Lady/Gentleman; second, a Scholar; and third, an Athlete.”

Ed Ross

For additional Poolesville HS team tryout schedule information please visit: https://phsboosterclub.wordpress.com/

MCPS Athletics Website: Parent Information & Health/Safety (Required Review) http://www.montgomeryschoolsmd.org/departments/athletics/

All required forms must to be given to the team Head Coach on, or before, the first tryout date.

Poolesville High School Ed Ross, Athletic Director 17501 W. Willard Road [email protected] Poolesville, Maryland 20837 301-972-7919 TABLE OF CONTENTS

All Required Forms must to be given to the team Head Coach on/or before, the first tryout date.

Fall Sports: Winter Sports: Spring Sports: Aug 12, 2015 November 14, 2015 March 1, 2016

For additional team tryout schedule information please visit - https://phsboosterclub.wordpress.com/

Section 1 - Athletic Program Philosophy

1. Philosophy of Athletic Participation 2-3. Triangle of Success 4-8. Athletic Program Expectations 9-10. Athletic Program Activities and Coaching Staff

Section 2 – Parent / Student Information:

11-12. What Do Student and Parents Need to Know 13-16. MCPS Student Information 17-21. MCPS Concussion Plan 22. Parent Fact Sheet on Concussion 23. Athlete Fact Sheet on Concussion 24. Concussion Card – Signs and Symptoms 25. Sudden Cardiac Arrest Information 26. Sudden Cardiac Arrest FAQ 27-28. Student / Parent Athletic Participation Information 29. Medical Exam Parent Doctor Information

Section 3 - Required Forms

30. * Student Information Sheet 31-32. * Student / Parent Athletic Participation Contract 33. * Consent Form – ImPACT Baseline Testing 34. * Concussion Awareness and Cardiac Arrest Awareness, Acknowledgement 35. * Pre-Participation Head Injury Concussion Reporting Form for Extracurricular Activities 36-39 . * Medical Exam Form – Turn in only the Pre-participation Clearance Page (last page) 40. * Emergency Medical Treatment Card 41. * Non-MCPS Transportation Form * Football Insurance – Issued separately by Head Football Coach

* Indicates Required Form: All forms must be given to the team head coach on or before the first tryout date

Once the team is chosen, a $30 MCPS ECA fee is required. This fee is paid to the MCPS ECA Office required before the first contest. For Online Payment please visit: www.montgomeryschoolsmd.org/departments/fms/payeca.shtm PARENT / STUDENT HANDBOOK

Section 1 Athletic Program Philosophy

PHILOSOPHY OF ATHLETIC PARTICIPATION

Edward J. Ross, Athletic Director

I believe that athletic activity participation serves to assist young people in their personal growth and development by reinforcing the valuable principles of sound leadership while promoting the importance of team work, reliability, loyalty, and dedication to achieving excellence. As well, participation in athletic activity teaches the importance of goal achievement and sportsmanship traits that teach competitors the value of upholding humility in victory and determination in defeat.

Although every competitive athlete and coach strives to be his or her very best, winning and losing become secondary issues when compared to the manner in which athletes and coaches conduct themselves on and off the field. While exhibiting dignity and grace in the face of adversity, our athletes and coaches must remain aware of a greater purpose to be first, ladies and gentlemen; second, scholars; and third, competitors.

In a much larger life perspective, scoreboard results become fleeting memories when compared to the lasting effect of an individual’s maximum effort toward a greater purpose. While it is true that competitors do not always perform at the same level, it is their dedicated commitment to excellence and positive attitude that define the core of their winning character; and with hope, the benefit of athletic participation will prepare the individual for success in a world beyond the athletic activity itself.

1 PARENT, COACH, PLAYER RELATIONSHIP “A TRIANGLE OF SUCCESS”

The following philosophy and suggested guidelines will serve to provide parents and coaches insight into how effective communication between parent, coach and player can form a “Triangle of Success.”

On one hand, many sport fans have become accustom to professional sport critical commentary that leads people to believe that they understand more about coaching a sport team than do the coaches; and without additional understanding, critical judgments are quick to be made that can damage the player, parent, coach relationship.

On the other hand, coaches will at times become so narrowly focused on strategies and personnel decisions that they overlook their responsibility to communicate with parents and players who desperately need additional understanding to be able to support a coach’s decisions.

The following philosophy is intended to create an awareness of the important relationships involved in a student-athlete’s successful athletic experience.

The Player/Coach Relationship:

The player/coach relationship is perhaps the most critical relationship in the partnership and it must begin with a sound philosophy based on an expertise of teaching athletic skills, techniques, competitive strategies and effective communication. In addition, this philosophy serves to assist players in their personal growth and development by reinforcing valuable leadership principles while promoting the importance of team work, responsibility, reliability, loyalty, and dedication to achieving excellence.

The coach and player must develop a working relationship based on an understanding of competitive athletics and a maximum effort toward achieving excellence, while exhibiting an attitude of dignity and respect in all circumstances.

Communication between coaches and players must be conducted in a manner that benefits the moral and ethical development of the student athlete, while adhering to boundaries that must be maintained between instructor and pupil, adult and young person.

The Parent-Coach Relationship:

While often given very little attention, the relationship between coaches and parents should always be a powerful alliance of support for players. The roles of coach and parent must share a common respect that holds players accountable for the pursuit of their goals. To the coach, parents are the team’s greatest assets.

Coaches must communicate a clear and consistent plan to parents, detailing player and team expectations; and they must recruit parental support whenever players get their priorities out of order. Coaches must also earn the trust of parents so that when difficult decisions must be made, the parent has a foundation to support the decision, even if he or she chooses to disagree.

Parents must allow the coach room to instruct and guide players into their roles as team members, while encouraging their sons and daughters in that no matter what their role on a team, it is most important to put forth their best positive efforts at all times. As well, parents should always strive

2 to support the coach in the presence of their sons and daughters while feeling free to communicate their disagreement with the coach. When parents choose to express negative opinions in the presence of players, it is likely that players will return to the next practice with similar attitudes and convictions, leaving the player viewed in a bad light among teammates and coaches who are easily affected by negative attitudes.

When parents have questions or concerns for a coach, it is best not to approach the coach immediately at the conclusion of a contest. At this time, coaches have other responsibilities and it is always best to share concerns when a coach can give full attention the matter. Parents must feel free to call the coach and if necessary, arrange a meeting so that important concerns can be shared and listened to in a calm, logical and mutually respectful manner.

The Parent-Player Relationship:

It is natural for parents to be deeply involved in their children’s activities but parents must allow players to learn and grow from their own experiences while participating in their chosen activity. Being positive and supportive of these experiences is important, but parents must be cautious as to not add undo pressure and unrealistic expectations which can deter from the athletic experience.

A good suggestion is for parents to allow players room to enjoy and grow from their experiences, whether good or bad. In numerous national studies, it has been determined that most athletes participate for enjoyment or fun, while excessive parental pressure or expectations can alter this most fundamental reason for playing.

When parents speak with players after a contest, a good start is to ask the player to share how he or she thinks he or she played, and what he or she enjoyed, and how the team played, and what was learned. Dwelling on mistakes or giving a disproportionate attention to successes can lead to problems. Hearing what the player has to say, and encouraging continued hard work and selfless team focus while always giving an individual maximum effort, helps players to become successful leaders and enhances an overall positive experience.

The Triangle:

As a relationship of three equal parts takes on the metaphorical appearance of an equilateral triangle, effective communication between coaches, parents and players results in a sound structure based on an alliance of cooperation and trust. With this in mind, we strive always to focus our efforts on the desired development of the student-athlete.

Edward Ross Athletic Director

3 Poolesville High School Athletic Program Expectations for Players, Parents and Coaches

Chain of Communication:

We follow the following chain of effective communication, so please try your best to work out details and problems in this manner.

 Team Captains  Coaches  Athletic Director  Principal

Expressing Concerns:

When expressing concerns with a coach, please refer to and use the following guidelines:

 Never approach a coach immediately after a contest. This is not the proper time or place for a discussion concerning your child or the team. If angry, allow for cooling off period.  Call the following day and make an appointment which is convenient for both you and the coach to meet.  Raise your concern in a calm and civil manner. Rude and obnoxious behavior, and the use of abusive language, will not help you communicate what you really want to say.  Once you have stated your question or concern, listen to the explanation. Often emotions override logic and reason. Listening receptively will help bring about necessary understanding.

Sportsmanship:

Since athletic activities are educational in nature, it is important that all parents, players and coaches demonstrate good sportsmanship that reflects a positive impression onto our community. Sportsmanship is an overt display of respect for the rules of sport and for all others. It also involves a commitment to fair play, ethical behavior, and integrity. This means:

 There can be no abusive or inappropriate language from our fans or spectators.  Spectators cannot leave the bleachers or enter onto the court or field during a contest.  Fans should be supportive and cheer positive encouragement for our team, and not against our opponent. Keep it Positive!  We will not allow negative comments or use of player numbers/names to be cheered against individual players. Make Nothing Personal!  Say Nothing Rude or Derogatory!  We should not impede or interfere with our opponent’s cheerleaders  School officials have the authority to remove a spectator(s) from a contest for unruly or improper conduct.  Possession of intoxicants and/or illegal substances is prohibited. Smoking is also prohibited on school grounds.

4 Treatment / Relationship with Officials:

Without a doubt, we will always question officiating calls that do not go our way. It’s part of the nature of healthy competition. However, there are some very important considerations to be made before criticisms become uncontrollable. First off, game officials agree to and follow a code of ethics and, although their judgments aren’t always perfect, they are the most informed professionals available to conduct the game by the agreed upon rules. As well, it should be noted that referees and umpires are always looking for new officials, so before expressing undo criticisms, please be sure to have your application completed, and your schedule freed up to work as an official.

It is also important to understand that officials rarely have an interest in who wins the game so their judgments and rule interpretations are what they are. Something else to know is that officials are rated, observed periodically and scrutinized by professionals, so please do not allow emotions to cause any embarrassment. As well, it is also important to remember that the game officials are in charge of the contest and they are charged with the safety of the event; and when needed, they have complete authority to have unruly spectators removed.

Spectator-Cheerleader:

Cheerleaders try to infuse positive spirit into the fans/spectators and lead them in selected cheers. When spectators take this responsibility into their own hands, it is not appropriate. Fans who come out of the stands to direct cheers may often cause or lead to confrontations with the opposing school. Therefore, following the leadership of our cheerleaders is absolutely necessary at all athletic contests. The emotion and atmosphere at athletic contests can be very exciting and the cheerleaders need to be allowed to direct and control this aspect of the event.

Acceptable Behavior for Coaches, Player and Parents

 Applaud during the introduction of players, coaches and officials  Recognizing a player’s good performance with applause.  Maintain composure with all decisions made by game officials regardless of opinions.  Treat the competition as an athletic event and NOT a War.  Search out and congratulate opposing coaches and players after contests.  Show concern for an injured player regardless of which team he or she plays.  Encourage only sportsmanlike conduct which exudes dignity and respect.

Unacceptable Behavior:

 Performing disrespectful, derogatory, or individually directed chants, songs, or gestures.  Excessive booing or continuous heckling an official’s decision.  Constant, loud criticism of officials and outward displays of anger over calls made  Antagonizing the opponents.  Refusing to shake hands or give recognition for good performances.  Blaming loss of game on officials, coaches, or participants  Taunting or name-calling to distract an opponent.  Using profanity or displays of anger that draws attention away from the game.  Performing your own cheers instead of following lead of the cheerleaders.

5 Responsibilities of an Athlete:

Most coaches and parents would expect an athlete to adhere to the following guidelines:

 Team goals, team welfare and team success come before individual desire.  Athletes must attend all practice sessions. Missed practices will result in restricted or suspended playing time, and eventual team dismissal.  Players must be cooperative, teachable, and receptive to instruction.  Team members are responsible for returning all issued uniforms and equipment.  Student-Athletes represent more than just themselves. They are ambassadors for their families, coaching staff, school and community.  All injuries, regardless of perceived severity, must be communicated to the coach.

Responsibilities of a Coach:

Coaches have the responsibility for the following:

 Selection of team members using objective and subjective methods of evaluation.  Determining the skills, techniques and strategies to be taught in their team system.  The organization of teaching and instruction for all practice sessions.  Determination of playing time for each player based on individual preparedness.  Decisions related to of who plays in what position.  Establishing and communication of team standards and expectations.  Selection of team captains and developing their leadership potential.  Establishing of the requirements to earn letter awards.  Communication with athletes and parents with respect to scheduled practice session times and objectives.

Participation and Team Selection:

It is important to understand that participation on a varsity interscholastic athletic team is a privilege and not a constitutional right. Remaining a member of a team means accepting all the responsibilities expected of a high school student-athlete. As well, unlike recreation or intramural teams, playing time in a varsity interscholastic athletic activity is by nature competitive and therefore not expected to be equal. In an effort to put the team in position to win the contest, a coach is required to use good judgment in putting players into proper position to meet the conditions and/or demands of the contest.

Every coach has the responsibility and authority for selecting his or her team. Criteria for selecting the team are developed by the coach and will be communicated to players and parents. Important to remember also is that returning team players do not automatically continue in the same playing capacity the next season; nor do senior players have priority over underclassmen. Having been a member of a team previously, or even being a senior, does not ensure that a player will be selected for the final roster. Parents should expect that every tryout player will be treated fairly and given every consideration. Coaches are sensitive to non-selected player disappointment and they will handle the task in a positive manner while being available to answer questions.

Coaches understand the disappointment felt by non-selected tryouts and parents, but there are times when selection decisions must be made. Anyone not selected for a team is encouraged to tryout again next season, or to try another sport.

6 The Purpose of a JV Team:

JV Teams exist to provide those athletes who are unable to participate on the varsity squad an opportunity to develop skills and gain experience. While the athlete’s age, size, or skill level may be the limiting factor in not making a varsity team, participation on a JV team may enhance the athlete’s potential to make the varsity squad in the future.

A caution, however, must also be given. Being a member of a JV team does not guarantee that an athlete will automatically move up the following year to the varsity squad. The athletes best suited for varsity competition will make the team roster each year.

Striving to win is important in athletics. However, compiling a great record or winning a championship should not be the primary objective of a JV team. The development of athletes should be the ultimate purpose of a JV squad, while at the same time acknowledging the value of winning, learning, and enjoying being a member of a team.

Practice Sessions and Games:

Practice sessions are normally open to spectators with the understanding that these sessions are the equivalent of a teacher’s classroom with real, quality instruction taking place. Interruptions and interference to an athlete’s concentration and focus during practice is not allowed. Practice sessions:

 Are limited to approximately two hours of instruction.  Are not allowed on Sundays or on dates restricted by the school system, or canceled when the daily school schedule is altered by inclement weather.  May be held on Saturdays.

Athletic Award Letters:

Coaches determine the requirements for the following Varsity Letter Awards:

 Varsity Certificate and Athletic Letter (One per entire high school career)  Sport pins, 2nd, 3rd, and 4th year letter pins  Senior Award for four years participation in a sport  Manager and Team Captain pins  Scholar Athlete and Sportsmanship Certificates (JV and Varsity)  Athletic Participation Certificate (JV, other non-varsity participation)

Team Captains and Managers:

There are several good reasons for having captains of a team. As leaders, these athletes serve as positive role models, links between the team and the coach, and help teammates to be successful.

While some coaches may allow their team to select captains, the ultimate responsibility of choosing leaders lies with the coach. It is also important to understand that serving as a captain is not reserved solely for seniors on a team, nor the most talented players, but rather, team captains are selected by their ability to handle the leadership responsibilities delegated by the coach.

Managers perform duties assigned by the coach and they answer only to the coach. They are not personal servants existing for the pleasure of players and will be treated with respect.

7 Risks of Athletic Participation:

In spite of using protective equipment, qualified supervision and sound instruction by our coaches, there are some risks associated with athletic participation. Injuries can and do occur. In extremely rare cases, death could also result. All athletes and parents need to be aware and understand this possibility. Coaches will always do all that we can to ensure a safe and healthy environment for athletes.

Booster Club:

Our Booster Club exists to support the entire athletic program. Our Booster Club has three primary goals:

 To provide financial support to the athletic department through fund raising activities.  To support and assist other needs of the athletic program.  To increase school spirit.  To encourage and promote good sportsmanship.

The Booster Club is not a vehicle to remove coaches, advance vested interests or to alter athletic department policy. It is a service and support organization working in harmony with the athletic program. The athletic director serves as the liaison between the booster leadership team and the principal. He serves as the advisor to the club and provides direction for purchasing athletic department and team needs. Consideration of requests is given to the budget, strategic plans and an overriding belief that any purchase should help the total athletic program and not a single team. Coaches and players must not approach the Booster Club with requests without first discussing matters with the athletic director.

8 Poolesville High School Falcons! Ed Ross, Athletic Director

We have a strong sense of school pride and spirit here at Poolesville and there is great support for our extracurricular activities. Our athletic team programs are open to all enrolled students, who have maintained at least a 2.0 marking period average and are in good health and we encourage participation as athletes, managers and statisticians.

We expect our Student-Athletes to carry themselves with confidence while conducting themselves first, as Ladies and Gentlemen; second, as Scholars; and third, as competitive Athletes. As Ladies and Gentlemen, our athletes are expected to conduct themselves with dignity and respect. As Students, our athletes are expected to maintain high academic and attendance standards; and as Athletes, our students are expected to give maximum effort in their preparation for success at varsity level competition.

Our athletic program is divided into three sport seasons: Fall (August-November), Winter (November-March), and Spring (March-June). Practices are held daily after school and on Saturdays, depending on the sport; and games are played after school, at night, or on Saturdays. Tryouts are held prior to each sport season and students must have a valid physical exam form signed by a doctor and dated within one year of participation, and parent permission.

All athletic department related information is linked to our Athletics/Booster website at https://phsboosterclub.wordpress.com/

The Athletic Department of Poolesville High School consists of the following sports or activities:

Fall (begins Aug 12, 2015) Winter (begins Nov 14, 2015) Spring (begins Mar 1, 2016)

Cheerleading (Varsity and JV) Basketball (Boys Varsity and JV) Baseball (Varsity and JV) Cross Country (Co-ed) Basketball (Girls Varsity and JV) Softball (Varsity and JV) Football (Varsity and JV) Indoor Track (Co-ed) Tennis (Boys) Field Hockey (Varsity and JV) Swimming/Diving (Co-ed) Track (Co-ed) Golf (Coed) Wrestling (Varsity and JV) Volleyball (Boys) Poms (Dance Team) Poms (continued) Volleyball (Co-ed) Soccer (Boys Varsity and JV) Varsity Cheerleading Lacrosse (Boys Varsity and JV) Soccer (Girls Varsity and JV) Lacrosse (Girls Varsity and JV) Tennis (Girls) Volleyball (Girls Varsity and JV)

Poolesville High School -- Falcons Coaching Staff, 2015-16

SPORT NAME EMAIL ADDRESS BASEBALL JV Bill Cartwright [email protected]

BASEBALL V Steve Osini [email protected]

BASKETBALL BOYS JV Larry Hurd [email protected]

BASKETBALL BOYS V Kenny Kramek [email protected]

BASKETBALL GIRLS JV Katie Hackey [email protected] BASKETBALL GIRLS V Jamie Jamison [email protected] CHEERLEADERS JV VACANT CHEERLEADERS V Chrissy Dabbondanza [email protected]

CROSS COUNTRY Asst Allison Wilder [email protected]

CROSS COUNTRY HC Prasad Gerard [email protected] FIELD HOCKEY JV VACANT FIELD HOCKEY V Rachel Stream [email protected] FOOTBALL Tyler Bierly [email protected] FOOTBALL Reggie Cross [email protected] FOOTBALL Mike Nesselt [email protected]

FOOTBALL Cody Martin [email protected] FOOTBALL Albert Surman [email protected]

FOOTBALL - HC Dave Murray [email protected] GOLF V Michelle Hunsicker-Blair Michelle_L_Hunsicker‐[email protected]

INDOOR TRACK Andrew Bortz [email protected]

INDOOR TRACK , HC Mike Trumbull [email protected] LACROSSE BOYS V Matt Fields [email protected] LACROSSE BOYS JV Tyler Bierly [email protected] LACROSSE GIRLS JV Will Gant [email protected] LACROSSE GIRLS V Brittany Hilton [email protected]

POMPONS Tanya Ventura [email protected] SOCCER BOYS JV Rod Nubgaard [email protected]

SOCCER BOYS V Christos Nicholas [email protected] SOCCER GIRLS JV George Penn [email protected]

SOCCER GIRLS V Justin Anderson [email protected] SOFTBALL JV Katie Hackey [email protected]

SOFTBALL V Laurie Wohnhas [email protected]

SWIMMING Jon Leong [email protected]

TENNIS BOYS Holly Dacek [email protected]

TENNIS GIRLS Holly Dacek [email protected]

TRACK & FIELD Andrew Bortz [email protected]

TRACK & FIELD, HC Michael Trumbull [email protected]

TRACK & FIELD Prasad Gerard [email protected] VOLLEYBALL BOYS Tiffany Grimes [email protected] VOLLEYBALL COED Megan Kenneweg [email protected] VOLLEYBALL GIRLS JV Megan Kenneweg [email protected] VOLLEYBALL GIRLS V Daniel DuVall [email protected]

WRESTLING JV Mark Agnew [email protected]

WRESTLING V Kevin Dorsey [email protected] WRESTLING V Tim Tao [email protected]

PARENT / STUDENT HANDBOOK

Section 2 Parent / Student Information What Do Students and Parents Need to Know? Helpful Information for Student-Athletes and Parents

Required Forms Students must complete and submit the following forms to the coach prior to participating in practices or tryouts. These forms are available at the school from either the coach or athletic director, or forms may be found on-line at the MCPS website.

• Pre-participation Physical Evaluation. The Pre-participation Physical Evaluation is valid for one year from the date of the exam, and covers participation for all sports within that time period. Students submit only the last page to the school/coach (Clearance Form). Schools keep the form on file. • Emergency Medical Card. This form must be submitted for each sport in which the student wishes to participate. • Student-Parent Participation Contract and Parent Permission Form. The form includes information that student-athletes and parents are required to review, including reference to the Health/Safety section of the MCPS Athletics website. This form must be submitted for each sport in which the student wishes to participate. • Consent Form – ImPACT Baseline Concussion Testing. A ll student-athletes must undergo baseline testing at least once every two years. This form indicates that the parent and student are aware of the purpose of baseline testing and that they consent for their child to undergo baselines testing. • Concussion Awareness and Sudden Cardiac Arrest Acknowledgement Statement. This form indicates that the parent and student-athlete have received and understand information regarding concussions and sudden cardiac arrest. • Pre-participation Head Injury/Concussion Reporting Form. This form indicates whether the student has previously suffered a concussion. • Transportation Form. This form is applicable when students are transported to games in cars. The coach of the team will provide this form if it is necessary for that sport. • Proof of Medical Insurance. This form is only required for football.

Information Important information regarding athletic participation, health and safety, and eligibility is included in the following sources, all of which are obtainable from the school and/or the MCPS Athletics website: http://www.montgomeryschoolsmd.org/departments/athletics.

• Student Information. This document includes four pages from the MCPS High School Athletics Handbook regarding a wide range of information affecting student-athletes, including eligibility, transfer rule, ejections, drug policies, attendance, etc. • Health and Safety. Parents and students are required to review the Health/Safety section of the MCPS Athletics website. The information included in this section is very important to the safety and welfare of students. • Student’s Rights and Responsibilities. Distributed to all students early in the school year. Includes criteria for participation and school system rules and regulations. Available in the main office of the school.

11 • Student-Parent Athletic Participation Information. Provides information on a thletic participation including eligibility requirements. Available on the MCPS Athletics website or the athletic director.

Ticket Prices/Admissions Information regarding ticket prices and season ticket options may be found in the Events section on the MCPS Athletics website.

Extracurricular Activity Fee (ECA) Students who are selected to participate on MCPS athletic teams must pay an extracurricular activities fee prior to competing in the first contest. The ECA fee is $30.00 per year and covers all extracurricular activities for the year. Information is sent home to students during the summer. Additional ECA fee information can be found by searching Extracurricular Activity Fee on the MCPS home page or the Parents/Student section of the MCPS Athletics website.

Tryout Dates for the 2014-2015 School Year The following are the tryout dates/ first practice dates for all fall, winter, and spring sports.

• August 13 through 16, 2014—Fall Sports (Equipment may be obtained on August 12)* • November 15, 2014—Winter Sports • February 28, 2015—Spring Sports

*Fall teams have the option of starting tryouts as early as August 13th. Teams must begin tryouts no later than August 17th. For all sports except golf, the first contest is approximately three weeks after the first practice.

Sportsmanship Sportsmanship is a primary mission of the MCPS interscholastic athletics program. MCPS has a comprehensive Sportsmanship Award Program in which parents and spectators are included in game ratings that ultimately decide schools and teams that win Sportsmanship Awards. Information regarding the MCPS Sportsmanship can be found on t he General Information for Parents page of the MCPS Athletics website. Sportsmanship fundamentals include:

• Fan support should be positive, respectful, and appropriate to a high school setting. • Parents discuss issues and concerns with coaches at appropriate times. Avoid times immediately before or after games. Appointments are best. • Spectators realize that officials must make judgment calls that are invariably disliked by one half of the fans. Accepting unfavorable calls by officials can be important learning opportunity for students.

Contests Cancellation Contests may be cancelled countywide due to inclement weather conditions, or locally at a school due to adverse field/playing conditions. Local schools can provide necessary, updated information. G enerally, when schools are cancelled, all athletic activities are cancelled. County–wide cancellation information can usually be found on the MCPS website, MCPS TV, @MCPSAthletics on Twitter, or local radio and television stations.

12 MCPS STUDENT INFORMATION

ELIGIBILITY

All students who achieve MCPS and MPSSAA eligibility standards have the opportunity to try out for teams in the interscholastic athletics program. The following are the MCPS eligibility standards required for participation.

1. Academic Eligibility The following items are interpretations of MCPS Policy IQD, Academic Eligibility for Extracurricular Activities, and M CPS Regulation IQD-RA, Academic Eligibility for Students Who Participate in Extracurricular Activities. a. A student must maintain a 2.0 unweighted grade point average (GPA) with no more than one failing grade in a marking period in order to participate in any athletic contests or to participate in or attend any practices during the next marking period. This regulation does not apply to students who are entering from a non-MCPS school or who are entering high school for the first time. Grades earned in High School Plus or Saturday School are not considered in determining a student’s athletic eligibility. b. When a student transfers from an MCPS high school to a non-MCPS high school and subsequently transfers back to MCPS, the grades the student earned at the non-MCPS high school will be us ed to determine academic eligibility, provided the student has attended the non-MCPS high school for at least one complete marking period. c. A multi-hour course is counted as multiple courses when determining whether a student has maintained a 2.0 GPA but is counted as one course when determining the number of failed classes. d. A grade of D or above shall be considered passing and a grade of E or NC (no credit) shall be considered failing. Each E or NC is factored in when determining the GPA. A grade of CR (credit) is not counted in determining the GPA. An unsatisfactory evaluation in a noncredit assignment, such as student aide, shall not be c onsidered failing for eligibility purposes. A grade of NG (no grade) is not to be included as either passing or failing in the calculation of the marking period average. e. When a student withdraws from a course after 25 days, the grade at the time of withdrawal will be used when determining eligibility for the next marking period. A student may not withdraw from more than one course after the 25-day drop/add period for eligibility purposes. This does not apply to withdrawal because of level of class, i.e., honors to regular class. When a student withdraws from school, the grades at the time of withdrawal are used in determining eligibility. f. A student passing all but one subject with at least a 2.0 GPA may participate in interscholastic athletics during the next marking period, provided that conduct and attendance have been satisfactory. Students taking a minimum of one or two courses must pass each course and maintain a 2.0 unweighted GPA to be eligible. g. On the day that the report card is issued, each coach or sponsor is responsible for verifying that all squad members are eligible and enforcing these eligibility standards. h. A student’s eligibility status begins on the day that a report card is issued and continues until the day that the next report card is issued. i. Grades reported as incomplete shall be considered passing grades for 10 school days after report cards are issued. Incomplete grades that are not changed to a passing grade within 10 school days will be considered failing for eligibility purposes.

13 j. Students who do not maintain a 2.0 GPA with no more than one failing grade during the final (fourth) marking period will not be eligible in the fall. Students have the opportunity to replace only one fourth marking period grade in which they received a “ D” or failing grade by repeating the course in summer school. If none of the fourth marking period courses in which the student received a “D” or failing grade are offered in summer school, the student will be allowed to take another course in the same subject area. If a c ourse in the same subject area is not available, then the student and his/her counselor may decide on an appropriate alternative course. The summer session grade from the appropriate alternative course will replace the lowest course grade from the fourth marking period and will be ap plied to determine the student’s eligibility status. This alternative course will replace the grade for eligibility purposes only; credit earned will be applied according to the course taken.

2. Age Refer to the MPSSAA Handbook Regulation .02, C.: “Students who are 19 years old or older as of August 31st are ineligible to participate in interscholastic athletics.”

For the 2014–2015, school year, a student’s birth date must be after August 31, 1995.

3. Attendance a. Participation in any athletic event or practice requires athletes to attend all of their scheduled classes on the day of the event or practice. Students who have prescheduled activities, such as a medical appointment, court appearance, driver's exam, or religious observance, will be permitted to participate in events/practices on the day of the absence, provided approval for the absence has been granted in advance. The athletic director in each school will establish a procedure for obtaining this approval and for handling unforeseen emergencies. Prior approval is not necessary for approved school activities. Students who have an excused absence on Fr iday may participate in athletic events on Saturday. b. A student who is absent from any class without obtaining prior approval may not participate in practices or contests on the day he/she is absent. c. Students who do not obtain prior approval and do pr actice will not compete in the first contest after the violation is verified. d. An athlete may not compete in the first scheduled contest after an unexcused absence is verified. e. During the semester exam schedule, students will be expected to attend their scheduled exams only. f. Repeated unexcused absences or chronic tardiness to any class will be sufficient reason for declaring a student ineligible at any time. The athletic director, in consultation with the coach, will determine the date and terms of ineligibility. g. Students must be o fficially registered and a ttending an M PSSAA member school. They may represent only the school in which they are registered and at which it is anticipated they will complete their graduation requirements.

4. Activity Fee for Extracurricular Activities Students who participate in the MCPS extracurricular activities program must pay an annual $30 fee. Information regarding this fee is mailed to the homes of all students in the summer. The fee can be pai d online at www.montgomeryschoolsmd.org/parents/. A student may not participate in an athletic contest until he or she has submitted the annual $30 extracurricular activity fee.

14

5. Medical Evaluation/Injuries, Illnesses, Surgery, Concussions All students who desire to participate in interscholastic athletics are required to have an annual medical evaluation performed by a licensed physician, certified physician assistant under the supervision of a licensed physician, or certified nurse practitioner. MCPS Form SRS-8: Pre- participation Physical Evaluation, is to be used to submit evidence of this examination. This examination is valid for one c alendar year except when the student has had a significant injury, illness, or major surgery. A student who has suffered a significant injury or significant illness, has had major surgery, or is suspected of having suffered a concussion is required to either submit a new medical evaluation or notification signed by a physician verifying that it is safe for the student to participate.

6. Preseason Requirements/Required Forms a. Before a student is allowed to try out or practice, he or she must submit a current medical evaluation (MCPS Form SRS-8), a s igned Student-Parent Participation Contract/Parent Permission Form, a complete medical emergency card, a baseline testing consent form, and two concussion-related forms. b. All students and parents are required to review certain health and safety information provided on the MCPS Athletics web page, including material on bas eline testing and concussions. c. Payment of the ECA fee must be verified prior to participating in a contest. d. A completed MCPS Form 560-31: Application to Participate in an Activity Away From School for Which MCPS Transportation Is Not Provided, must be submitted if students drive or are driven in cars to contests. e. Students must submit other forms or contracts as required by the school.

7. Transfer Rule A student who transfers or receives a Change of School Assignment (COSA) from his/her home attendance area school without a change of residence of the parents or legal guardian will be ineligible to participate in athletics for one calendar year from the date of enrollment at the new school. If unusual circumstances exist, a student may appeal the ineligibility in writing to Dr. William G. Beattie, director of systemwide athletics, 850 Hungerford Drive, Room 200, Rockville, Maryland 20850. A c opy of an approved MCPS Form 335-45: Change of School Assignment (COSA), must accompany the appeal.

Middle school students who legally attended school outside of their residence area and who wish to remain in that pattern will need to reapply for a transfer at the high school level. If a COSA or transfer is granted under this condition, athletic ineligibility is waived automatically.

REGULATIONS

1. All-Star Games All-star games are not organized or administered by MCPS. Only seniors may participate, and only after the end of the season. The MPSSAA Handbook states in Section .04, D., (5) that “Individual students may participate in two all-star games per sport, upon the completion of their eligibility in the sport in which this participation occurs.”

2. Amateur Standing Refer for the MPSSAA Handbook Regulation .10 (Amateur Rules).

15 3. Ejections from Contests Athletes who are ejected, suspended, or otherwise permanently removed from a contest for unsafe or unacceptable behavior, including red cards, two yellow cards, or their equivalent, are not eligible to participate in the next contest. Impacted players shall not be on the sidelines during the existing contest or during the next contest. Coaches shall notify the athletic director in writing of the ejection/suspension and date(s) of exclusion. This rule applies to regular season as well as postseason.

4. Drugs and Alcohol Regulation Any MCPS student-athlete with verified use, distribution, or possession of alcohol, tobacco, illegal drugs, and/or controlled substances on school property or at a school-sanctioned event, is prohibited from participating in athletic activities for a m inimum of 10 c onsecutive school days (including any intervening non-school days). The student will be eligible for athletic activities on the eleventh school day.

Individual schools may create a more stringent penalty than that stated above consistent with the philosophy of its administration and community.

5. Outside Participation Refer to MPSSAA Handbook Regulation .02G(1) (Eligibility).

6. Participation on More Than One Team in a Season Students shall not be p ermitted to participate in more than one i nterscholastic sport in one season. If a student leaves one team and has not participated in a contest, he/she may join a second team if the coaches of each team agree. The athletic director must be not ified in writing. The following exceptions are: a. Cheerleaders and po mpons may participate on another team if they receive permission from the coach, the sponsor, and the athletic director. b. Girls’ tennis players may participate in the region mixed doubles and state tournament in the spring.

7. Years/Seasons of Eligibility Refer to MPSSAA Handbook regulation .02D (Eligibility). MCPS students are expected to complete their graduation requirements in four years. MCPS students may not participate in athletics in their fifth year of high school unless extraordinary circumstances prevail that prevent the student from graduating in four years. The appeal is directed to the principal.

8. Suspensions Suspended or excluded students are ineligible for extracurricular activities until they are reinstated in classes. This includes in-school suspensions. Students suspended on Friday may not participate until they are reinstated on the subsequent school day (Monday).

16 Concussion Plan

Montgomery County Public Schools (MCPS) Guidelines and Procedures Regarding Concussions/Head Injuries

MCPS guidelines and procedures for student-athletes who sustain head injuries/concussions conform to recommendations by the Department of Health and Human Services Centers for Disease Control and Prevention (CDC), the National Federation of High Schools (NFHS), the Maryland Public Secondary Schools Athletics Association (MPSSAA), and the Maryland State Department of Education (MSDE). Information and forms referenced in the MCPS Concussion Plan are located under Concussions in the Health and Safety section of the MCPS Athletics web page at the following address: (http://www.montgomeryschoolsmd.org/departments/athletics).

The MCPS Concussion Plan includes the following elements:

A. Education 1. Coaches 2. Players/Parents B. Baseline Testing C. Athletic Trainers D. Procedures 1. General Procedures 2. Coach Procedures 3. Nurse Procedures E. Return-to-Play F. Forms and Documents G. Limitations on Full Contact

A. Education

1. MCPS coaches will:

a) Review annually the MCPS Concussion Plan b) Receive training and instruction regarding head injuries in Prevention and Care of Athletic Injuries, a course required for coaching certification at Maryland public schools. c) Complete every two years the NFHS Coaches’ Education Course: Concussions in Sports—What You Need to Know. d) Review Coach Resource Materials in the Health and Safety section of the MCPS Atheltics web page. e) Have available at practices and contests the MCPS Concussion Quick Reference Card. f) Receive relevant guidance and information at school and systemwide coaches’ meetings. g) Inform parents and players of guidelines and procedures regarding concussions. h) Present a PowerPoint to players on health and safety information, including concussions.

17 2. Players and parents will:

a) Receive a letter describing the MCPS Concussion Plan. b) Receive an information sheet published by the CDC on symptoms and procedures regarding concussions (Head’s Up—A Fact Sheet for Parents). c) Be encouraged to review additional health and safety materials regarding concussions in the Health and Safety section of the on the MCPS Athletics web page d) Sign/Submit the MPSSAA forms Pre-participation Head Injury/Concussion Reporting Form and Concussion Awareness (Parent/Student-Athlete Acknowledgement Statement). e) Receive verbal instruction from coaches at practices (players) and/or parent preseason meetings (parents) regarding concussions. f) Indicate on the MCPS Student-Parent Athletic Participation Contract that they have reviewed safety and health-related information made available by the school system, including concussions.

B. Baseline Testing

1. All MCPS student-athletes will participate in baseline concussion testing at the beginning of the season. Student-athletes must take a baseline test every two years. 2. Parents will receive a letter describing the MCPS Baseline Testing Plan. 3. Details regarding ImPACT baseline concussion testing are described in the Baseline Testing Plan in the Health and Safety section of the MCPS Athletics web page.

C. Athletic Trainers

1. Athletic trainers have been assigned to all 25 MCPS high schools. 2. Athletic trainers will be available at practices and contests. The “home” team athletic trainer will assist with injuries sustained by both the home and visiting team. 3. Athletic trainers will assist in implementing baseline concussion testing and “gradual return- to-play” protocol after a student is cleared by to resume participation after a concussion.

D. Procedures

1. General Procedures

a) Any player who exhibits signs or symptoms consistent with a concussion shall be removed from the practice or contest and shall not return to play until cleared by an authorized health care provider—the clearance must be signed. b) The player’s parents shall be informed that their son or daughter may have suffered a concussion and shall be advised to take their child to an authorized health care provider as soon as possible. The parent will be issued the MPSSAA form Medical Clearance for Suspected Head Injury. c) Appropriate school personnel, including administrators, athletic director, athletic trainer, and school nurse, will be informed of the injury. Appropriate follow-up will be initiated, including potential academic accommodations. d) If the player suffered a concussion, he/she may begin a supervised gradual return to play process on the date indicated on the form Medical Clearance for Suspected Head Injury.

18 e) The player’s gradual return to full activity is supervised by school staff over a five-day period, according to the MPSSAA form Graduated Return to Play Protocol. Generally, the school athletic trainer will supervise gradual return to play protocol. f) The player may resume full participation after he or she successfully completes a supervised, gradual return-to-play protocol.

2. Coach / Athletic Trainer / Athletic Director Procedures

When a student-athlete suffers a potential concussion:

a) The coach or athletic trainer removes the student-athlete from the practice or contest. b) The coach, designee, or athletic trainer calls 911 and/or student-athlete’s parent (Emergency Cards should always be available for this purpose). c) In instances when it is fairly clear that the student-athlete has suffered a concussion, the coach/designee/athletic trainer calls emergency personnel (911) and the student-athlete’s parents. d) In instances where the student-athlete displays only mild symptoms, the coach/designee/athletic trainers calls the parent, and asks whether the parent wants to pick the student-athlete up immediately or whether to call 911. e) If the parent cannot be contacted, the coach/designee/athletic trainer calls the emergency contact person designated on the Emergency Medical Card. f) A coach/designee/athletic trainer should remain with the student-athlete at all times until either a parent or emergency personnel arrive. g) A student-athlete should not be allowed to go home unless accompanied by a parent or an adult designated by the parent. h) The coach or athletic trainer presents to the parent the MPSSAA form Medical Clearance for Suspected Head Injury. This form provides instructions to parents, including that the parent or student-athlete must take the form to an appropriate health care provider, and bring the completed form to the school nurse as soon as possible after the injury. i) The coach follows school protocol in notifying appropriate school staff that a potential concussion (or serious injury) has occurred. At a minimum, the coach notifies the athletic director the afternoon or evening after the practice or contest ends when a student-athlete has been removed from participation because of a potential concussion. The athlete director then informs the athletic trainer and school nurse (unless the athletic trainer is already aware). j) The coach, with assistance from the athletic trainer, completes and submits a Student Accident Report to the athletic director the next school day. k) The athletic director informs the school nurse of the injury on or before the start of the next school day following the injury. l) The school nurse follows-up with the student-athlete, and notifies the athletic director when the student may resume participation. The athletic director informs the athletic trainer and coach. m) The athletic director and the athletic trainer retain copies of the completed Medical Clearance for Suspected Head Injury and the athletic trainer enters on the applicable database that a concussion has occurred. n) If the injury was a concussion, the coach and athletic trainer initiate procedures described in the form Graduated Return to Play Protocol.

19 3. Nurse Procedures

a) The school nurse implements follow-up procedures described in High School Student- Athlete Probable Head Injury Flow Chart. b) These procedures include separate courses of action based on whether the injury occurred during the school day or after school. c) These procedures also include separate courses of action based on whether or not the student-athlete has suffered a concussion. d) After following the procedures described in the flow chart, the student-athlete may resume a supervised gradual return to play once the nurse returns to the athletic director a copy of the medical clearance (Medical Clearance for Suspected Head Injury).

E. Return-to-Play

1. Student-athletes who are removed from a practice or contest because they exhibit signs or symptoms consistent with a concussion must have written medical clearance before they may return to play. The medical clearance shall be indicated on the MPSSAA form titled Medical Clearance for Suspected Head Injury. 2. The form is given to parents of student-athletes who have potentially suffered a concussion, and includes procedures on how the student-athlete may obtain clearance to resume participation. The form must be completed and signed by an authorized health care provider. 3. The completed form is returned to the school nurse when the student-athlete returns to school. 4. The form includes two separate clearances. If a student-athlete has not suffered a concussion, the health care provider indicates such at the top of the form and there is no need for a follow-up examination. 5. If the top portion of the form indicates that the student-athlete has suffered a concussion, the student-athlete may not resume participation until receiving clearance from a health care provider (bottom portion of form). 6. The school nurse informs the athletic director when the student-athlete may initiate a gradual return to play program, and provides a copy of the completed form Medical Clearance for Suspected Head Injury. The athletic trainer informs the coach and athletic trainer. 7. The coach or athletic trainer monitors Gradual Return to Play Protocol over a five day period. 8. If the student-athlete remains symptom-free, he or she may return to full participation after the five-day gradual return-to-play period. 9. The school files and retains copies of all of the forms associated with the student-athlete’s concussion for a period of five years.

20 F. Forms and Documents

1. Concussion / Baseline Testing Information for Players and Parents a) Concussion Information for Parents b) Baseline Testing Information for Parents c) Head’s Up - A Fact Sheet for Parents d) Head’s Up - A Fact Sheet for Students

2. Concussion / Baseline Testing Forms a) Consent Form – ImPACT Baseline Concussion Testing b) Pre-Participation Head Injury/Concussion Report Form for Extracurricular Activities c) Concussion Awareness (Parent/Student-Athlete Acknowledgement Statement) form d) Medical Clearance for Suspected Head Injury e) Graduated Return to Play Protocol

3. Concussion Administrative Information a) MCPS Concussion Plan b) MCPS Baseline Testing Plan c) Concussions in Sports – What You Need to Know [NFHS Course] d) High School Student-Athlete Probable Head Injury Flow Chart

G. Limitations on Full Contact

The five pages that follow are MSDE recommendations on limiting exposures to potential concussions in collision, contact, and limited contact sports.

21 A FACT SHEET FOR PARENTS HEADSIN HIGHUP SCHOOL CONCUSSION SPORTS What is a concussion? How can you help your child prevent a A concussion is a type of traumatic brain injury. Concussions concussion or other serious brain injury? are caused by a bump or blow to the head. Even a “ding,” • Ensure that they follow their coach’s rules for safety and “getting your bell rung,” or what seems to be a mild bump the rules of the sport. or blow to the head can be serious. • Encourage them to practice good sportsmanship at all times. You can’t see a concussion. Signs and symptoms of concussion • Make sure they wear the right protective equipment for can show up right after the injury or may not appear or be their activity. Protective equipment should fit properly noticed until days or weeks after the injury. If your child and be well maintained. reports any symptoms of concussion, or if you notice the • Wearing a helmet is a must to reduce the risk of a serious symptoms yourself, seek medical attention right away. brain injury or skull fracture. – However, helmets are not designed to prevent What are the signs and symptoms of a concussions. There is no “concussion-proof” helmet. concussion? So, even with a helmet, it is important for kids and If your child has experienced a bump or blow to the head teens to avoid hits to the head. during a game or practice, look for any of the following signs of a concussion: What should you do if you think your child has a concussion? SYMPTOMS REPORTED SIGNS OBSERVED BY SEEK MEDICAL ATTENTION RIGHT AWAY. A health care BY ATHLETE PARENTS/GUARDIANS professional will be able to decide how serious the concussion is and when it is safe for your child to return to • Headache or • Appears dazed or regular activities, including sports. “pressure” in head stunned KEEP YOUR CHILD OUT OF PLAY. Concussions take time to • Nausea or vomiting • Is confused about heal. Don’t let your child return to play the day of the injury • Balance problems or assignment or and until a health care professional says it’s OK. Children who position dizziness return to play too soon—while the brain is still healing— • Double or blurry • Forgets an risk a greater chance of having a repeat concussion. Repeat vision instruction or later concussions can be very serious. They can cause • Sensitivity to light • Is unsure of game, permanent brain damage, affecting your child for a lifetime. • Sensitivity to noise score, or opponent • Moves clumsily TELL YOUR CHILD’S COACH ABOUT ANY PREVIOUS • Feeling sluggish, CONCUSSION. Coaches should know if your child had a • Answers questions hazy, foggy, or previous concussion. Your child’s coach may not know about slowly groggy a concussion your child received in another sport or activity • Concentration or • Loses consciousness unless you tell the coach. memory problems (even briefly) • Confusion • Shows mood, If you think your teen has a concussion: behavior, or • Just “not feeling right” Don’t assess it yourself. Take him/her out of play. personality changes or “feeling down” Seek the advice of a health care professional.

It’s better to miss one game than the whole season. For more information, visit www.cdc.gov/Concussion. 22 April 2013 #(#%65*''6(14 "5)-&5&4
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61*/
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4$)00- $0/$644*0/ 410354 Concussion facts: What should I do if I think I have • A concussion is a brain injury that affects how your a concussion? brain works. DON’T HIDE IT. REPORT IT. Ignoring your symptoms and • A concussion is caused by a bump, blow, or jolt to the trying to “tough it out” often makes symptoms worse. head or body. Tell your coach, parent, and athletic trainer if you think • A concussion can happen even if you haven’t been you or one of your teammates may have a concussion. knocked out. Don’t let anyone pressure you into continuing to practice • If you think you have a concussion, you should not or play with a concussion. return to play on the day of the injury and not until GET CHECKED OUT. Only a health care professional a health care professional says you are OK to return can tell if you have a concussion and when it’s OK to to play. return to play. Sports have injury timeouts and player substitutions so that you can get checked out and the What are the symptoms of a concussion? team can perform at its best. The sooner you get checked Concussion symptoms differ with each person and with out, the sooner you may be able to safely return to play. each injury, and they may not be noticeable for hours or days. Common symptoms include: TAKE CARE OF YOUR BRAIN. A concussion can affect your ability to do schoolwork and other activities. Most • Headache athletes with a concussion get better and return to • Confusion sports, but it is important to rest and give your brain • Difficulty remembering or paying attention time to heal. A repeat concussion that occurs while your • Balance problems or dizziness brain is still healing can cause long-term problems that may change your life forever. • Feeling sluggish, hazy, foggy, or groggy • Feeling irritable, more emotional, or “down” How can I help prevent a concussion? • Nausea or vomiting Every sport is different, but there are steps you can take • Bothered by light or noise to protect yourself. • Double or blurry vision • Follow your coach’s rules for safety and the rules of • Slowed reaction time the sport. • Sleep problems • Practice good sportsmanship at all times. • Loss of consciousness During recovery, exercising or activities that involve a lot of concentration (such as studying, working on the If you think you have a concussion: computer, or playing video games) may cause concussion Don’t hide it. Report it. Take time to recover. symptoms to reappear or get worse.

It’s better to miss one game than the whole season. For more information, visit www.cdc.gov/Concussion. 23 April 2013 1. CONCUSSIONS - SIGNS AND SYMPTOMS 3. ON-FIELD MENTAL STATUS EVALUATION*

Athletes who experience one or more of the signs and (This mental status assessment is recommended for high school-age symptoms listed below after a bump, blow, or jolt to the head or body may have a concussion. athletes and older. Any inability of the athlete to respond correctly to the questions below should be considered abnormal.)

Signs Observed* Symptoms Reported Orientation by Athlete* What period/quarter/half are we in? Headache or “pressure” Appears dazed or stunned What stadium/field is this? in head Is confused about assignment or Who is the opposing team? Nausea or vomiting position Who scored last? Balance problems What team did we play last? Forgets an instruction or dizziness Anterograde Amnesia Is unsure of game, Double or blurry vision Ask the athlete to repeat the following words: Girl, Dog, Green score, or opponent Moves clumsily Sensitivity to light Retrograde Amnesia Answers questions slowly Sensitivity to noise Ask the athlete the following: Feeling sluggish, hazy, Loses consciousness (even briefly) Do you remember the hit? foggy, or groggy What happened in the play prior to the hit? Shows mood, behavior, Concentration or What happened in the quarter / period prior to the hit? or personality changes memory problems Can’t recall events What was the score of the game prior to the hit? Confusion prior to hit or fall Concentration Can’t recall events Just not “feeling right” Ask the athlete to do the following: after hit or fall or is “feeling down” Repeat the days of the week backwards (starting with today) 2. ACTION PLAN Repeat these numbers backward 36 (63), 419 (914), 6294 (4926) Word List Memory

If you suspect that an athlete has a concussion, you should take the Ask the athlete to repeat the three words from earlier: Girl, Dog, Green following three steps:

1. Remove the athlete from practice or play. 4. RETURN TO PLAY

2. Inform the athlete’s parent or guardian about the possible concussion and provide the parent/guardian with the MCPS form 1. In order to return to play – practices or games – the athlete must Parent Notification of Possible Head Injury/Medical Clearance Form submit a Parent Notification of Possible Head Injury/Medical by Authorized Health Care Provider. Clearance Form by Authorized Health Care Provider signed by an

authorized health care provider. 3. Keep the athlete out of play until an authorized health care provider indicates that the student may return to play. An athlete may not 2. Authorized health care providers include licensed physicians, return to practice or a contest on the same day that he or she has certified physician’s assistants under the supervision of a licensed sustained a concussion. physician, or certified nurse practitioners.

Source: The Department of Health and Human Services Centers for Disease Control and Prevention (CDC)

24

Sudden Cardiac Arrest (SCA) Information for Parents and Student Athletes

Definition: Sudden Cardiac Arrest (SCA) is a potentially fatal condition in which the heart suddenly and unexpectedly stops beating. When this happens, blood stops flowing to the brain and other vital organs.

SCA in student athletes is rare; the chance of SCA occurring to any individual student athlete is about one in 100,000. However, student athletes’ risk of SCA is nearly four times that of non-athletes due to the increased demands on the heart during exercise.

Causes: SCA is caused by several structural and electrical diseases of the heart. These conditions predispose an individual to have an abnormal rhythm that can be fatal if not treated within a few minutes. Most conditions responsible for SCA in children are inherited, which means the tendency to have these conditions is passed from parents to children through the genes. Other possible causes of SCA are a sudden blunt non-penetrating blow to the chest and the use of recreational or performance-enhancing drugs and/or energy drinks.

Warning Signs of SCA Emergency Response to SCA  SCA strikes immediately.  Act immediately; time is most critical to increase  SCA should be suspected in any athlete who has survival rates. collapsed and is unresponsive.  Recognize SCA. o No response to tapping on shoulders  Call 911 immediately and activate EMS. o Does nothing when asked if he/she is OK  Administer CPR.  No pulse  Use Automatic External Defibrillator (AED).

Warning signs of potential heart issues: The following need to be further evaluated by your primary care provider.  Family history of heart disease/cardiac arrest  Fainting, a seizure, or convulsions during physical activity  Fainting or a seizure from emotional excitement, emotional distress, or being startled  Dizziness or lightheadedness, especially during exertion  Exercise-induced chest pain  Palpitations: awareness of the heart beating, especially if associated with other symptoms such as dizziness  Extreme tiredness or shortness of breath associated with exercise  History of high blood pressure

Risk of Inaction: Ignoring such symptoms and continuing to play could be catastrophic and result in sudden cardiac death. Taking these warning symptoms seriously and seeking timely appropriate medical care can prevent serious and possibly fatal consequences.

Information used in this document was obtained from the American Heart Association (www.heart.org), Parent Heart Watch (www.paretnheartwatch.org), and the Sudden Cardiac Arrest Foundation (www.sca-aware.org). Visit these sites for more information. 25 Frequently Asked Questions about Sudden Cardiac Arrest (SCA)

What are the most common causes of Sudden Cardiac Arrest (SCA) in a student athlete?

SCA is caused by several structural and electrical diseases of the heart. These conditions predispose an individual to have an abnormal rhythm that can be fatal if not treated within a few minutes. Most conditions responsible for SCA in children are inherited, which means the tendency to have these conditions is passed from parents to children through the genes. Some of these conditions are listed below. 1. Hypertrophic cardiomyopathy (HCM): HCM involves an abnormal thickening of the heart muscle and it is the most common cause of SCA in an athlete. 2. Coronary artery anomalies: The second most common cause is congenital (present at birth) abnormalities of coronary arteries, the blood vessels that supply blood to the heart. 3. Other possible causes of SCA are: a. Myocarditis: an acute inflammation of the heart muscle (usually due to a virus). b. Disorders of heart electrical activity such as: i. Long QT syndrome. ii. Wolff-Parkinson-White (WPW) syndrome. iii. Catecholaminergic Polymorphic Ventricular Tachycardia (CPVT). c. Marfan syndrome: a condition that affects heart valves, walls of major arteries, eyes, and the skeleton. d. Congenital aortic valve abnormalities. 4. Commotio Cordis: concussion of the heart from sudden blunt non-penetrating blow to the chest 5. Use of recreational, performance-enhancing drugs, and energy drinks can also bring on SCA.

How can we minimize the risk of SCA and improve outcomes?

The risk of SCA in student athletes can be minimized by providing appropriate prevention, recognition, and treatment strategies. One important strategy is the requirement for a yearly pre-participation screening evaluation, often called a sports physical, performed by the athlete’s medical provider. 1. It is very important that you carefully and accurately complete the personal history and family history section of the “Pre-Participation Physical Evaluation Form” available at http://www.mpssaa.org/HealthandSafety/Forms.asp. 2. Since the majority of these conditions are inherited, be aware of your family history, especially if any close family member: a. had sudden unexplained and unexpected death before the age of 50. b. was diagnosed with any of the heart conditions listed above. c. died suddenly /unexpectedly during physical activity, during a seizure, from Sudden Infant Death Syndrome (SIDS) or from drowning. 3. Take seriously the warning signs and symptoms of SCA. Athletes should notify their parents, coaches, or school nurses if they experience any of these warning signs or symptoms. 4. Schools in Maryland have AED policies and emergency preparedness plans to address SCA and other emergencies in schools. Be aware of your school’s various preventive measures. 5. If a cardiovascular disorder is suspected or diagnosed based on the comprehensive pre-participation screening evaluation, a referral to a child heart specialist or pediatric cardiologist is crucial. Such athletes will be excluded from sports pending further evaluation and clearance by their medical providers.

26 STUDENT-PARENT ATHLETIC PARTICIPATION INFORMATION Montgomery County Public Schools (MCPS)

Philosophy Interscholastic athletics supplement and support the academic mission of the school system and assist students in their growth and development. Athletics assists in promoting the importance of teamwork, effort, goals, and commitment. Interscholastic athletics is highly competitive, but winning is not the primary measure of success. Sportsmanship, respect for participants, and dignity in the face of adversity are more important than the outcome of the contest. All athletes do not perform at the same level, but all can demonstrate effort, dedication, and sportsmanship.

Sportsmanship An important mission of the interscholastic athletics program is to teach and reinforce values relating to sportsmanship, competition, and fair play. It is expected that team personnel, parents, and spectators respect this mission by exhibiting appropriate behavior at athletic events. Countywide team and school awards are presented annually to schools whose coaches, players, and fans, demonstrate a high degree of sportsmanship.

Student Eligibility Requirements Students must meet the following requirements to be eligible to participate. Participation of ineligible students shall result in individual and team sanctions, including forfeits for the team. 1. Students must submit a current MCPS Pre-participation Physical Evaluation Form (MCPS Form SR- 8), a Medical Card for Athlete (MCPS Form 560-30), and a Student/Parent Athletics Participation Contract before being allowed to participate in practices or contests. 2. Students selected for a team must pay the MCPS extracurricular activities (ECA) fee. Students may not participate in contests until they have paid the activities fee. 3. Students must achieve a minimum 2.0 grade point average for the most recently completed marking period, with no more than one failing grade. Academic eligibility is determined on the date report cards are issued and remains until the next report card is issued. 4. Students must attend all of their scheduled classes in order to participate in a practice or contest on that day. If the principal or designee grants an excused absence in advance for a prescheduled activity or an unforeseen emergency, the student may participate on that day. 5. If during the season a student has an unexcused absence, he/she may not compete in the next contest after the violation has been verified. 6. In addition to other infractions, a student may be suspended or removed from a team for unexcused absences or chronic tardiness to classes or team practices. 7. Students who are 19 years old or older as of August 31 of the current school year are ineligible. 8. Students may not participate in more than one interscholastic sport in one season. 9. A student may not participate when he/she is serving an in-school or out-of-school suspension. The student becomes eligible to participate on the next school day following the suspension. 10. Students must satisfy school and school system Participation Standards. 11. Students whose legal residence is outside the designated boundary of a particular school may not participate unless they have received a Change of School Assignment (COSA) and athletic waiver. 12. Students should refer to A Student’s Guide to Rights and Responsibilities for additional guidelines and regulations related to eligibility.

Hazing Hazing is prohibited at all times. Hazing involves any act that subjects teammates to mental or physical discomfort, embarrassment, harassment, or ridicule. In some instances, hazing constitutes a criminal act. At a minimum, hazing may lead to immediate dismissal from a team.

27 Assumption of Risk Participation in interscholastic athletic activities often includes intense competition and poses the potential for serious, catastrophic, or life-threatening injury. Participants and parents are urged to consider that there are inherent risks and hazards associated with athletic participation. Risks vary from sport-to-sport and can occur under direct supervision and with use of proper safety equipment.

Health and Safety Parents and students are required to review health and safety related information provided on the MCPS Athletics website http://www.montgomeryschoolsmd.org/departments/athletics. The website includes information on MRSA, hygiene, heat acclimatization, hydration, head injuries, and steroids. If a student or parent cannot access the MCPS Athletics website, the school will provide the required information.

Communication with Coaches Parents should not attempt to address coaches immediately after games and practices. Coaches have many post game/practice responsibilities, including supervision of players. Also, the post-game/practice period is often emotionally charged and not conducive to productive discussion. If a parent feels a need to communicate a concern, the parent should contact the coach and/or athletic director to arrange a later meeting.

Electronic Communications Parents and students are expected to utilize appropriate, positive use of social media, e-mail messages, blogs, websites, and other electronic communications. Parents and students shall not make inflammatory or derogatory comments and/or post inappropriate descriptions or pictures regarding students, staff members, coaches, and/or other teams or schools.

Participation Expectations and Standards Participation in interscholastic athletics is a privilege. Accordingly, students must meet certain standards in order to earn the privilege of participation. At a minimum, the following standards are required of all student-athletes. 1. Exhibit public behavior that will reflect positively on the team, school, and community. 2. Exhibit responsible, respectful, and trustworthy behavior to teammates and the coach. 3. Exert efforts to maintain a high level of academic achievement. 4. Comply with all team, school, and school system rules, regulations, and policies. 5. Exhibit appropriate behavior at all team and school-related activities. 6. Attend all team functions unless ill or given prior permission to be absent by the coach. 7. Respect and comply with decisions made by the coach, athletic department, and game officials. 8. Report to the coach any issues or developments that may affect eligibility status. 9. Comply with safety and health precautions distributed and emphasized by the school system.

Residency MCPS residency regulations require that students attend specific high schools, assigned by the school system, based on their legal residence. When a student participates at a school to which he or she is not assigned, or the home address provided is not the legal residence, the student is not eligible to participate unless the student has received a COSA, based on accurate information, and has received an athletic waiver from the director of systemwide athletics. A COSA and an athletic waiver also are required when a student moves out of a school’s boundary area and desires to continue to attend and participate at that school.

Illegal Substances/Alcohol/Tobacco/Steroids/Controlled Substances MCPS athletic regulations state that any student-athlete with verified use, distribution, or possession of alcohol, tobacco, illegal drugs, and/or controlled substances on school property or at a school-sanctioned event, shall receive a minimum ten-consecutive school day suspension from all athletic activities. Participation in athletic activities will not resume until the school day following completion of the suspension. Individual schools may adopt a more-stringent regulation or penalty than that stated above.

28 PRE-PARTICIPATION PHYSICAL EVALUATION FOR ATHLETICS MONTGOMERY COUNTY PUBLIC SCHOOLS Maryland State Department of Education Rockville, Maryland 20850 Maryland State Department of Health

PRE-PARTICIPATION PHYSICAL EVALUATION FOR ATHLETICS

To Parents or Guardians: Students enrolled in grades 9-12 must have an annual pre-participation physical evaluation in order to participate in Montgomery County Public Schools (MCPS) interscholastic athletics and school conditioning programs. Students enrolled in grades 7-8 must have a medical evaluation every two years to participate in the MCPS middle school interscholastic athletics program. The medical evaluation shall be performed by a licensed physician, a certified nurse practitioner, or a certified physician assistant under the supervision of a licensed physician. The pre-participation physical evaluation consists of four parts: History Form (page 1), Supplemental History Form for Athletes with Special Needs (page 2), Physical Examination Form (page 3), and Clearance Form (page 4). The student must turn in only the last page (CLEARANCE FORM—page 4) to the school or coach prior to participation. The physician should retain the first three pages. When a student- athlete has experienced a significant injury, illness, or surgery after submitting the annual pre-participation physical evaluation, a clearance letter from a physician, nurse practitioner, or certified physician assistant under the supervision of a licensed physician is required to resume participation. The health information submitted to the school will be available only to those health and education personnel who have a legitimate educational interest in your child. Exemptions from physical examinations are permitted if they are contrary to a student’s religious beliefs. In such circumstances, the family should submit verification.

MCPS Form SR-8, July 2012

29 PARENT / STUDENT HANDBOOK

Section 3 Required Forms Student/Parent Information

Student Information

Student Name ______Student ID ______First MI Last

Street Address ______

City ______State ______Zip ______

Cell Phone ______Email Address ______

Date of Birth ______Grade ______

Sport ______Years Participated in This Sport ______

Name of Last School Attended ______

Parent Information

Parent/Guardian #1: Parent/Guardian #2: Name Phone (Cell) Phone (Home) Phone (Work) Email

Student Medical History - (Check all that apply)

ADHD Dental Problem Kidney/Bladder Problems ADD Diabetes Menstrual Problems Allergy: Bee Sting Disability – Physical Orthopedic Condition Allergy: Food Earaches/Infections – Frequent Seizure Disorder Allergy: Latex Eczema Sore Throats – Frequent Allergy: Medication Fainting Spells Speech Problem Allergy: Pesticide/Chemical* Gastrointestinal Disorder Stomachaches – Frequent Allergy: Seasonal Headaches – Frequent Vision Problem – Anorexia/Bulimia Hearing Problem/Wears Aids Wears Glasses/Contacts Asthma Heart Condition Other:______

If any of above items have been checked, you must notify our school health room professional of any condition indicated and/or medication needed.

In case of accident or serious illness, I request that school staff attempt to contact me. If I cannot be reached, I hereby authorize the head coach, assistant coach and/or athletic trainer to make reasonable arrangements to be in the best interest of the child

Signature of Parent or Guardian ______Date ______

30 MONTGOMERY COUNTY PUBLIC SCHOOLS STUDENT-PARENT ATHLETIC PARTICIPATION CONTRACT AND PARENT PERMISSION FORM

Student: Student ID:

School: Team: School Year:

Parent and Student-Athlete: Review this contract carefully (front and back), complete information as requested, affix signatures, and return the completed contract/permission form to the school.

Stipulations We have received and read the Student-Parent Athletic Participation Information. B ased on this information, we understand and stipulate to the following: 1. I/We understand the eligibility regulations required for participation and affirm that all eligibility requirements have been satisfied, including age, residence, and academics. 2. I/We understand that participation of ineligible players will result in individual and team sanctions, including forfeits for the team. 3. I/We affirm that the student will exert effort to maintain a high level of academic achievement. 4. I/We understand there is potential for serious, catastrophic, or life-threatening injury associated with participation in a sport. 5. I/we have reviewed safety and health information made available by the school system, including information regarding concussions, MRSA, hygiene, heat acclimatization, hydration, and steroids. 6. I/We affirm that the student will not participate in hazing at any time, of any nature. 7. I/We, as a participant or spectator, will exhibit a high level of sportsmanship at contests. 8. I/We will follow appropriate procedures in communicating concerns to coaches. 9. I/We affirm that the student will abide by all team and participation standards. 10. I/We will utilize appropriate, positive use of technology, including social media and other electronic communications. 11. I/We affirm that the student will not use steroids, illegal drugs, alcohol, and t obacco unless medically prescribed for a specific condition or illness.

Residency Verification In order to be e ligible, students must be legally enrolled at a hi gh school designated by the school system based on their legal primary address. Please respond to the following residency questions:

A. I reside at MD Street Address City Zip Code B. This residence is within the boundaries of High School/Consortium C. I reside at this residence with my parent(s) or legal guardian: yes no D. My current address is the same as last year: yes no E. I have only played at my current high school: yes no F. I agree to notify the coach / school of any changes in residence: yes no

Permission to Participate I/We hereby authorize and consent to our child’s participation in interscholastic athletics and sports. We understand that the sport in which our child will be p articipating is potentially dangerous, and that physical injuries may occur to our child requiring emergency medical care and treatment. I/We assume the risk of injury to our child that may occur in an athletic activity.

31 In consideration of the acceptance of our child by the Montgomery County Public Schools (MCPS) in its athletic program, and the benefits derived by our child from participation, I/we agree to release and hol d harmless the Board of Education of Montgomery County, its members, the Superintendent of Schools, the principal, all coaches, and any and all other of their agents, servants, and/or employees, as well as entities that provide training to MCPS coaches and/or athletes as part of the school system’s athletic program, and agree to indemnify each of them from any claims, costs, suits, actions, judgment, and expenses arising from our child’s participation in interscholastic athletics.

I/We hereby give our consent and authorize the Board of Education of Montgomery County and its agents, servants, and/or employees to consent on our behalf and on behalf of our child, to emergency medical care and t reatment in the event we are unable to be not ified by reasonable attempts of the need for such emergency medical care and treatment.

Each year, MCPS makes available a student accident insurance policy at a nominal premium. This insurance is secondary to the family's own insurance. Because accidents will inevitably occur despite our best efforts to maintain a hi gh level of safety in all student activities, this insurance coverage is recommended unless the family deems that other insurance coverage (in force) will meet the needs of the student. The student accident insurance policy is available at the beginning and throughout the school year. The coverage may be obtained from the insurance carrier. Forms are available at the school.

I, , and I, (parent’s name) (student’s name) have carefully reviewed the Student- Parent Athletic Participation Information and the Student/Parent Athletic Participation Contract and Parent Permission Form. I/We understand the conditions for participation in the MCPS interscholastic athletic program, and we understand there are inherent risks associated with participation.

I/We agree as follows: • My son/daughter has my/our permission to participate in (name of sport) at ______High School. • I/We understand and conform to all of the statements in the Stipulations portion of the Contract. • I/We I have responded truthfully and accurately to the questions in the Residency portion of the Contract.

Please affix signatures below.

Signature of Parent or Legal Guardian Date Signature of Parent or Legal Guardian Date

Signature of Student Date

*In the event that both parents retain legal guardianship of the student, the signatures of both parents are required.

32 Consent Form ImPACT Baseline Concussion Testing

We have read the information provided by Montgomery County Public Schools (MCPS) and information outlined in the Health and Safety section of the Athletics page of the MCPS website regarding baseline concussion testing and ImPACT (Immediate Post-concussion Assessment and Cognitive Testing). We understand the contents and agree to complete baseline concussion testing in order to participate in interscholastic athletics. A baseline concussion test is good for two years – a student-athlete would need to retake the test every two years.

We also give our consent to have a retest administered in the event of a concussion. We know that it is our responsibility to request a retest (or multiple retests) from the school. The school will not automatically administer a retest in the event of a concussion or suspected concussion.

We understand that a student-athlete must be cleared by a medical professional in order to return to play following a concussion or suspected concussion. Results of the ImPACT test or retests do not have to be utilized in order to return to participation. But in many instances ImPACT tests can provide valuable information that can assist medical professionals in making decisions on when a student may safely resume participation. We understand that there is no cost to parents for retests.

Furthermore, we give permission for the school-assigned vendor to release the ImPACT results to our child’s primary care physician, neurologist, or other testing physician, as indicated below. I/We also understand that general information about the test data may be provided to our child’s guidance counselor and teachers, for the purpose of providing temporary academic modifications, if necessary, following a concussion.

Student Name: ______Sport______

______Signature of Student-Athlete Date

______Signature of Parent/Guardian Date

33

For official use only: Name of Athlete______Sport/season______Date Received______

Concussion Awareness and Sudden Cardiac Arrest Awareness Parent/Student Athlete Acknowledgement Statement

Parent/Guardian

I acknowledge that I have read and understand the following:

. Sudden Cardiac Arrest (SCA) Information Sheet

. Concussion Awareness Information Sheet

______Date ______PRINT NAME PARENT/GUARDIAN SIGNATURE

Student Athlete

I acknowledge that I have read and understand the following:

. Sudden Cardiac Arrest (SCA) Information Sheet

. Concussion Awareness Information Sheet

______Date ______PRINT NAME STUDENT ATHLETE SIGNATURE

34

PRE-PARTICIPATION HEAD INJURY/CONCUSSION REPORTING FORM FOR EXTRACURRICULAR ACTIVITIES

This form should be completed by the student’s parent(s) or legal guardian(s). It must be submitted to the Athletic Director, or official designated by the school, prior to the start of each season a student’ plans to participate in an extracurricular athletic activity.

Student Information Name: Grade: Sport(s): Home Address:

Has student ever experienced a traumatic head injury (a blow to the head)? Yes______No______If yes, when? Dates (month/year): ______

Has student ever received medical attention for a head injury? Yes______No______If yes, when? Dates (month/year): ______If yes, please describe the circumstances:

Was student diagnosed with a concussion? Yes______No______If yes, when? Dates (month/year): ______Duration of Symptoms (such as headache, difficulty concentrating, fatigue) for most recent concussion:

Parent/Guardian: Name: ______(Please print)

Signature/Date ______

Student Athlete: Signature/Date ______

35 ■■ Preparticipation Physical Evaluation  HISTORY FORM (Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.)

Date of Exam ______Name ______Date of birth ______Sex ______Age ______Grade ______School ______Sport(s) ______

Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking

Do you have any allergies?  Yes  No If yes, please identify specific allergy below.  Medicines  Pollens  Food  Stinging Insects

Explain “Yes” answers below. Circle questions you don’t know the answers to. GENERAL QUESTIONS Yes No MEDICAL QUESTIONS Yes No 1. Has a doctor ever denied or restricted your participation in sports for 26. Do you cough, wheeze, or have difficulty breathing during or any reason? after exercise? 2. Do you have any ongoing medical conditions? If so, please identify 27. Have you ever used an inhaler or taken asthma medicine? below:  Asthma  Anemia  Diabetes  Infections 28. Is there anyone in your family who has asthma? Other: ______29. Were you born without or are you missing a kidney, an eye, a testicle 3. Have you ever spent the night in the hospital? (males), your spleen, or any other organ? 4. Have you ever had surgery? 30. Do you have groin pain or a painful bulge or hernia in the groin area? HEART HEALTH QUESTIONS ABOUT YOU Yes No 31. Have you had infectious mononucleosis (mono) within the last month? 5. Have you ever passed out or nearly passed out DURING or 32. Do you have any rashes, pressure sores, or other skin problems? AFTER exercise? 33. Have you had a herpes or MRSA skin infection? 6. Have you ever had discomfort, pain, tightness, or pressure in your 34. Have you ever had a head injury or concussion? chest during exercise? 35. Have you ever had a hit or blow to the head that caused confusion, 7. Does your heart ever race or skip beats (irregular beats) during exercise? prolonged headache, or memory problems? 8. Has a doctor ever told you that you have any heart problems? If so, 36. Do you have a history of seizure disorder? check all that apply:  High blood pressure  A heart murmur 37. Do you have headaches with exercise?  High cholesterol  A heart infection 38. Have you ever had numbness, tingling, or weakness in your arms or  Kawasaki disease Other: ______legs after being hit or falling? 9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, 39. Have you ever been unable to move your arms or legs after being hit echocardiogram) or falling? 10. Do you get lightheaded or feel more short of breath than expected 40. Have you ever become ill while exercising in the heat? during exercise? 41. Do you get frequent muscle cramps when exercising? 11. Have you ever had an unexplained seizure? 42. Do you or someone in your family have sickle cell trait or disease? 12. Do you get more tired or short of breath more quickly than your friends 43. Have you had any problems with your eyes or vision? during exercise? 44. Have you had any eye injuries? HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No 45. Do you wear glasses or contact lenses? 13. Has any family member or relative died of heart problems or had an 46. Do you wear protective eyewear, such as goggles or a face shield? unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)? 47. Do you worry about your weight? 14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan 48. Are you trying to or has anyone recommended that you gain or syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT lose weight? syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic 49. Are you on a special diet or do you avoid certain types of foods? polymorphic ventricular tachycardia? 50. Have you ever had an eating disorder? 15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator? 51. Do you have any concerns that you would like to discuss with a doctor? 16. Has anyone in your family had unexplained fainting, unexplained FEMALES ONLY seizures, or near drowning? 52. Have you ever had a menstrual period? BONE AND JOINT QUESTIONS Yes No 53. How old were you when you had your first menstrual period? 17. Have you ever had an injury to a bone, muscle, ligament, or tendon 54. How many periods have you had in the last 12 months? that caused you to miss a practice or a game? Explain “yes” answers here 18. Have you ever had any broken or fractured bones or dislocated joints? 19. Have you ever had an injury that required x-rays, MRI, CT scan, ­injections, therapy, a brace, a cast, or crutches? 20. Have you ever had a stress fracture? 21. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down syndrome or dwarfism) 22. Do you regularly use a brace, orthotics, or other assistive device? 23. Do you have a bone, muscle, or joint injury that bothers you? 24. Do any of your joints become painful, swollen, feel warm, or look red? 25. Do you have any history of juvenile arthritis or connective tissue disease? I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

Signature of athlete ______Signature of parent/guardian______Date______

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission 36is granted to reprint for noncommercial, educational purposes with acknowledgment. HE0503 9-2681/0410 ■■ Preparticipation Physical Evaluation  THE ATHLETE WITH SPECIAL NEEDS: SUPPLEMENTAL HISTORY FORM

Date of Exam ______Name ______Date of birth ______Sex ______Age ______Grade ______School ______Sport(s) ______

1. Type of disability 2. Date of disability 3. Classification (if available) 4. Cause of disability (birth, disease, accident/trauma, other) 5. List the sports you are interested in playing Yes No 6. Do you regularly use a brace, assistive device, or prosthetic? 7. Do you use any special brace or assistive device for sports? 8. Do you have any rashes, pressure sores, or any other skin problems? 9. Do you have a hearing loss? Do you use a hearing aid? 10. Do you have a visual impairment? 11. Do you use any special devices for bowel or bladder function? 12. Do you have burning or discomfort when urinating? 13. Have you had autonomic dysreflexia? 14. Have you ever been diagnosed with a heat-related (hyperthermia) or cold-related (hypothermia) illness? 15. Do you have muscle spasticity? 16. Do you have frequent seizures that cannot be controlled by medication? Explain “yes” answers here

Please indicate if you have ever had any of the following. Yes No Atlantoaxial instability X-ray evaluation for atlantoaxial instability Dislocated joints (more than one) Easy bleeding Enlarged spleen Hepatitis Osteopenia or osteoporosis Difficulty controlling bowel Difficulty controlling bladder Numbness or tingling in arms or hands Numbness or tingling in legs or feet Weakness in arms or hands Weakness in legs or feet Recent change in coordination Recent change in ability to walk Spina bifida Latex allergy

Explain “yes” answers here

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

Signature of athlete ______Signature of parent/guardian______Date______

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission 37is granted to reprint for noncommercial, educational purposes with acknowledgment. ■■ Preparticipation Physical Evaluation  PHYSICAL EXAMINATION FORM Name ______Date of birth ______PHYSICIAN REMINDERS 1. Consider additional questions on more sensitive issues • Do you feel stressed out or under a lot of pressure? • Do you ever feel sad, hopeless, depressed, or anxious? • Do you feel safe at your home or residence? • Have you ever tried cigarettes, chewing tobacco, snuff, or dip? • During the past 30 days, did you use chewing tobacco, snuff, or dip? • Do you drink alcohol or use any other drugs? • Have you ever taken anabolic steroids or used any other performance supplement? • Have you ever taken any supplements to help you gain or lose weight or improve your performance? • Do you wear a seat belt, use a helmet, and use condoms? 2. Consider reviewing questions on cardiovascular symptoms (questions 5–14).

EXAMINATION Height Weight  Male  Female BP / ( / ) Pulse Vision R 20/ L 20/ Corrected  Y  N MEDICAL NORMAL ABNORMAL FINDINGS Appearance • Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency) Eyes/ears/nose/throat • Pupils equal • Hearing Lymph nodes Heart a • Murmurs (auscultation standing, supine, +/- Valsalva) • Location of point of maximal impulse (PMI) Pulses • Simultaneous femoral and radial pulses Lungs Abdomen Genitourinary (males only)b Skin • HSV, lesions suggestive of MRSA, tinea corporis Neurologic c MUSCULOSKELETAL Neck Back Shoulder/arm Elbow/forearm Wrist/hand/fingers Hip/thigh Knee Leg/ankle Foot/toes Functional • Duck-walk, single leg hop aConsider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam. bConsider GU exam if in private setting. Having third party present is recommended. cConsider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.

 Cleared for all sports without restriction  Cleared for all sports without restriction with recommendations for further evaluation or treatment for ______ Not cleared  Pending further evaluation  For any sports  For certain sports ______Reason ______Recommendations ______I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If condi- tions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Name of physician (print/type) ______Date ______Address ______Phone ______Signature of physician ______, MD or DO

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. 38 HE0503 9-2681/0410 ■■ Preparticipation Physical Evaluation  CLEARANCE FORM

Name ___­­­­­______Sex  M  F Age ______Date of birth ______ Cleared for all sports without restriction  Cleared for all sports without restriction with recommendations for further evaluation or treatment for ______ Not cleared  Pending further evaluation  For any sports  For certain sports______Reason ______Recommendations ______

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Name of physician/nurse practitioner (print/type) ______Date ______Address ______Phone ______Signature of physician/nurse practitioner______ itle______

EMERGENCY INFORMATION Allergies ______Other information ______

______

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission 39is granted to reprint for noncommercial, educational purposes with acknowledgment. 40 Office of the Deputy Superintendent of Schools APPLICATION TO PARTICIPATE IN AN ACTIVITY MONTGOMERY COUNTY PUBLIC SCHOOLS AWAY FROM SCHOOL FOR WHICH Rockville, Maryland 20850 MCPS TRANSPORTATION IS NOT PROVIDED

PART I: To Be Completed by Student

Student Name Date / / Last First MI School Grade Date(s) to be excused from classes: / / , / / , / / From : To : a.m./p.m. a.m./p.m. Reason (describe activity)

For transportation in connection with this activity I will: (check one) Ⅺ Use public transportation facilities Ⅺ Ride in a car driven by a fellow student. Name of Driver Ⅺ Drive my own or my parents’/guardians’ car with no passengers. Ⅺ Other (specify)

Ⅺ Drive my own or my parents’/guardians’ car with (number) passengers. PART II: To Be Completed by Principal/Designee The student named above may be excused to engage in the activity described above. The activity Ⅺ is Ⅺ is not school-sponsored. School Staff Sponsor (if applicable) The attendance will be recorded as: Ⅺ Present Ⅺ Absent (other codes are also used)

/ / Signature, Principal/Designee Date PART III: To Be Completed by Parent, Legal Guardian, or Eligible Student Read carefully before signing. The Board of Education of Montgomery County and its servants, agents, and employees does not insure transportation as described in PART I. The school system does carry liability insurance, which, under terms of the coverage, may apply to a school-sponsored activity. In no case would coverage be provided for activities designated as non-school-sponsored. The owner of the vehicle must carry bodily injury insurance of $100,000 per individual or $300,000 per accident. I as parent (or legal guardian) of the student named above, or as eligible student, give permission for the named student to be transported in the manner described in PART I. I as parent (or legal guardian) of the student named above, or as eligible student, give permission for the named student to participate in the above-described activity. I release, acquit, forever discharge, and agree to and do indemnify and save harmless the Board of Education of Montgomery County and its servants, agents, and employees from any and all future liability resulting from any and all claims or causes of action which I now or may in the future have for personal injuries, damage to property, loss of services, medical expenses, and losses or damages of any and every kind whatsoever that may arise from the transportation to and from the activity described above. If this is a non-school-sponsored activity, I un- derstand that this release also applies to participation in any non-school-sponsored activity.

PARENT FINANCIAL RESPONSIBILITY The Montgomery County Public Schools (MCPS) and School wish to advise par- ents and guardians of the potential financial responsibility they may incur in the event that the activity named above is cancelled, delayed, interrupted, or revised. A decision may be made by the school or by MCPS, in accordance with the MCPS School Travel Policy, to cancel the trip for safety or other reasons. In the event of such a cancellation, the trip operator’s cancellation policies, as well as those of the hotels, bus companies and others providing services in connection with the trip, will determine the amount of any refund to which you are entitled, if any. This will depend upon the date any cancellation occurs. As you would expect, the closer to the date of the trip that a cancellation occurs, the more likely you will receive a smaller refund due to non-refundable payments made by the trip operator to others on your behalf. Please note that, while trip operators generally will make every effort to minimize your financial exposure in the event of a cancellation, we are unable to anticipate the amount of any refund at this time should the trip be cancelled. In addition, please be advised that, for safety or other reasons, the trip may be delayed or interrupted once it is underway. In that event, it may be necessary for students to remain away for an extended time, thereby incurring additional room and board costs. It may also be necessary to modify itineraries or other travel arrangement, thereby requiring additional transportation costs. Neither MCPS nor School will be responsible for any additional costs that may be incurred as a result of any delay, interruption or revision to the trip.

By signing below, parents and guardians acknowledge they have read this notice and accept responsibility for any loss of trip fees due to cancellation and any potential additional costs that may be incurred as a result of any delay, interruption or revision to the trip.

/ / Signature, Parent, Legal Guardian, or Eligible Student Date

MCPS Form 560-31, Rev. 3/05 Parent Emergency Phone Number - - 41