Great Oak High School 2017-18 Athletic/Activities Packet Welcome

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Great Oak High School 2017-18 Athletic/Activities Packet

Welcome to GOHS Athletics/Activities

"Coming together is a beginning; keeping together is progress; working together is success."

We strongly believe that our athletic and activities program fosters and enriches the positive climate of Great Oak High School. Athletics and activities at Great Oak are an extension of the instructional program, providing an environment for students to extend their learning and make positive connections to school. GOHS continues to provide comprehensive athletic and activity offerings. Teams will compete in the Southwestern League. We look forward to another exciting year!

Gil Rodriguez, Don Skaggs Assistant Principal, Athletics Activities Director

A New Athletic Packet – including a new physical – is required each school year. ONLY ONE PHYSICAL IS REQUIRED PER YEAR. YOU MUST TURN IN THE COMPLETED ATHLETIC PACKET TO ATHLETIC OFFICE BEFORE TRYING OUT!

When completing the packet:

ST PHYSICALS MUST BE DATED AFTER MAY 1 , 2017 AND BE COMPLETED BY AN M.D. OR D.O.

 Please read the entire packet  Print pages 8 – 14 and sign in places indicated. Completing all areas Including both copies of 9 and 10.  Take pages 13-14 to the Dr. with you. Must be an M.D. or a D.O. and have the doctor complete them, including a Dr.’s Office Stamp. NAME ADDRESS AND PHONE MUST BE LEGIBLE  Bring completed packet, pages 8 – 14, to the Athletic Office where you will receive an approval stamp and a copy of your clearance form. (The complete packet remains on file in the Athletic Office)  Take that clearance form to the coach on the day of tryouts/practice/camp.  Only one Athletic Clearance Packet is required each year –  Additional copies of approval form will be given to the athletes as needed  Great Oak High School 32555Deer HollowWay Temecula, CA 92592 (951) 294-6450 x 2004 FAX – 951-294-6453 P a g e | 2

ATTENTIONATHLETES

CALIFORNIA INTERSCHOLASTIC FEDERATION CIF Southern Section Academics/Integrity/Athletics

CONDENSED ELIGIBILITY RULES

STUDENTS, TO PROTECT YOUR ATHLETIC ELIGIBILITY YOU MUST:

• Be under nineteen years of age prior to June 15 • Have reached the ninth grade • Participate in no more than four seasons of the same sport after enrolling in the ninth grade • Be scholastically eligible (2.0 minimum GPA) • File an Application for Residential Eligibility if you have transferred from another school without a corresponding bona-fide change of residence by your parents/guardians, or you are a foreign student • Since entering the ninth grade, not be in your ninth semester of attendance • Meet citizenship requirements • Maintain amateur standing • Not have participated in any tryout for a professional team • Maintain in your school files an annual physical examination certifying that you are physically fit to try out and/or participate in athletic activities

YOUR ELIGIBILITY IS SUBJECT TO SPECIAL RULES: (Questions should be directed to your school Coach and/or Athletic Director)

• Competition with an outside team during your high school season in the same sport is prohibited • Participation on the varsity football team is prohibited until you have reached your 15th birthday (14 with a letter from your physician and parent) • If you transfer from one school to another without a bona-fide change of residence by your parents/guardians, your eligibility is subject to special rules which may include non-participation at the varsity level. – Additional transfer paperwork is required. • Students may participate in All-Star competition, between conclusion of the Southern Section season of sport and September 1.

You are urged to check with the Athletic Director or Coach if you have any questions regarding your eligibility. Competing when you are not eligible could subject your team to Forfeiture. P a g e | 3

TEMECULA VALLEY UNIFIED SCHOOL DISTRICT ATHLETIC/ACTIVITIES CODE OF CONDUCT

Student Responsibilities Participation in the GOHS Activities/Athletic Programs (See Exhibit A) is a privilege and a responsibility. Students who participate in the GOHS programs understand the privilege and agree to uphold the responsibilities below: The Responsibility to self to maintain high standards of health and safety in order to perform at the maximum level of their potential. The Responsibility to their fellow group/team members to give their best effort at all times. The Responsibility to their coaches, advisors and directors to strive for success in every effort they undertake. The Responsibility to their school, community, whom they represent, to maintain the highest standards of conduct. The Responsibility to attend school in order to participate in a practice or event that day. The Responsibility to the youth of the community, who look up to them, to be role models of citizenship and behavior.

Parent Responsibilities Participants are not under the supervision of school authorities twenty-four hours a day. In order to involve parents/guardians in the supervision of their son/daughter, it is asked that they (working in partnership with the school) take responsibility for code enforcement outside of the school’s jurisdiction for their own children. If the parent or guardian reports a violation by the participant, the parent or guardian may request the enforcement of the appropriate consequences as outlined in the Activities/Athletic Code. Should school authorities become aware of a possible violation of the Activities/Athletic Code, parents or guardians will be notified.

Staff Responsibilities School personnel will be responsible for assisting students in meeting their responsibilities under the Code. Coaches and advisors play a key role in educating and being role models for the students enrolled in their sport or activity. Coaches and advisors are responsible for educating students and enforcing all aspects of the Activities/Athletic Code. It is essential that a caring and positive approach be used to convey to students their responsibilities and the consequences to students if the Code is violated. The school administration will be responsible for administering all consequences to students for violation of this code.

Consequences The following are the cumulative* penalties and regulations regarding any infractions of the Activities/Athletic Code which will be applied IN ADDITION TO and AFTER students have complied with the consequences of the regular school discipline program which include suspension and expulsion.

FIRST OFFENSE: Upon notification by school authority, the student will miss the next two events of EVERY sport/activity of which she/he is currently a member. Participation during the past twelve (12) months for the date of code violation constitutes membership. The two-event sanction will apply during the following twelve (12) month period.

SECOND OFFENSE: Upon notification by school authority, the student will be excluded from participation in the activity/athletic program for twelve (12) months from the date of the code violation.

THIRD OFFENSE: Upon notification by school authority, the student will be excluded from participation in the activity/athletic program for the duration of his/her attendance at GOHS. * These penalties are cumulative during a student’s tenure at GOHS P a g e | 4

APPEAL PROCESS

Students and parents/guardians may meet with the school administration to appeal a student’s proposed removal from an activity or athletic team. The following procedures shall apply

The authorized administrator shall confer with any student who is under consideration for removal from an activity or athletic team prior to taking such action During the conference, the student shall be advised of the reasons for the proposed removal and the evidence in support of these reasons and afforded an opportunity to respond to the charges or allegation. After the conference, the authorized administrator shall then determine whether remove the student from an activity or an athletic team.

 If the authorized administrator decides to remove the student from an activity or athletic team, the student’s parent or guardian shall be advised of the decision.  If requested, the authorized administrator shall confer with the student’s parent or guardian concerning the decision to remove their child or ward from an activity or athletic team. At the conference, the authorized administrator shall discuss the reasons for the removal, the duration of the removal, and the other matters related to the remove.

CIF ATHLETES CODE OF ETHICS Athletics is an integral part of the school’s total educational program. All school activities, curricular and extracurricular, in the classroom and on the playing field, must be congruent with the school’ s stated goals and objectives established for the intellectual, physical, social and moral development of its students. It is within this context that the following Code of Ethics is presented.

As an Athlete, I understand that it is my responsibility to:

1. Place academic achievement as a highest priority. 2. Show respect for teammates, opponents, officials, and coaches. 3. Respect the integrity and judgment of game officials. 4. Exhibit fair play, sportsmanship and proper conduct on and off the playing field. 5. Maintain a high level of safety awareness. 6. Refrain from the use of profanity, vulgarity, and other offensive language and gestures. 7. Adhere to the established rules and standards of the game 8. Respect all equipment and use it safely and appropriately. 9. Refrain from the use of alcohol, tobacco, illegal and nonprescription drugs, anabolic steroids or any substance to increase physical development or performance that is not approved by the United States Food and Drug Administration, Surgeon General of the United States, or American Medical Association. Participate in the use of Tobacco or Criminal Behavior as defined in the California State Education Code and or Penal Code 10. Know and follow all state, section and school athletic rules and regulations as they pertain to eligibility and sports participation. 11. Win with character, lose with dignity.

Violations of the Activity/Athletic Code include, but are not limited to:

Illegal possession, use, or sale of drugs, alcohol, or tobacco.

1. Assault and/or battery 2. Theft 3. Forgery 4. Weapons 5. Other criminal acts as defined by the California State Education Code/Penal Code and determined to be serious in nature by the Great Oak High School Administration. Copies of the California State Education Code can be made available on request. Participants shall not engage in any incidents involving possession, sale, or use or furnishing of firearms, knives, or other weapons, theft, forgery, any violation of Education Code sections 48900 (a-l), 48900.2, 48900.e and/or 48900.4. Any such incidents will result in removal from the activity or athletic team in accordance with the CONSEQUENCES section of this code. P a g e | 5

ATHLETIC/ ACTIVITIES ACADEMIC ELIGIBILITY REQUIREMENTS

In order to be academically eligible, a student MUST meet ALL of the following minimum standards on their previous progress report or semester report card. Students MUST:

1. Be PASSING four classes AND have a GPA of 2.0. Students not meeting the 2.0 may request probation for one eligibility period. ONLY ONE PROBATION PERIOD WILL BE ALLOWED PER YEAR. FOR EXAMPLE IF YOU USE PROBATION DURING A FALL SPORT AN ATHLETE MAY NOT USE PROBATION FOR A WINTER OR SPRING SPORT. 2. No more than two F’s, 3. No more than one U (in Citizenship or Work Habits). Two U’s from the same teacher will count as one. 4. Students entering GOHS from a non-TVUSD school must be passing four classes on their last grade report and will have until their first GOHS grade report to meet the above standards. 5. All TVUSD incoming freshmen will be required to meet all the above standards. The June report card will be used to determine eligibility for FALL SPORTS. 6. 10 Day Grace Period - A student may leave a sport for any reason during the first 10 days of practice. There shall be NO PENALTY if the athlete informs the coach of such intention to leave that sport and returns all school equipment or gear issued to him or her. Any spirit pack items purchased are non refundable. 7. Release from Team - An athlete may, at any time, request to be released from a team due to special circumstances. The coach may or may not grant this request. If granted, the parent will be notified by mail. 8. Quitting a Team - If an athlete informs the coach that he/she is quitting, after the 10 day grace period, the athlete will miss the first contest of the next sport he/she participate in. The athlete MAY NOT PRACTICE in another sport until the conclusion of the last regularly scheduled contest of the sport quit. The parent will be notified. Any spirit pack items purchased prior to quitting are not refundable. 9. Removal from a Team - If an athlete is removed from a team for violation of any team rules; the athlete will miss the first two contests of the next sport he/she participates in. The athlete MAY NOT practice in another sport until the conclusion of the last regularly scheduled contest of the sport he/she was removed from. The parents will be notified by the coach and may appeal the coach’s decision to the athletic director.

10. Travel Policy - the biggest cost in high school athletics is transportation. Transportation will be arranged in the safest, yet most cost effective manner possible.  Transportation – Options to all contests will be determined prior to each season of sport.  Student Driver - Due to special circumstances, a student may request his/her coach’s permission to drive to a contest. NO passengers are allowed. Student must have prior guardian approval.  Private vehicle transportation - Students may ride in a private vehicle driven by a coach or adult volunteer. Student must have prior guardian approval  School Bus/Van - District bus rules are in effect on all athletic field trips.  Transportation home - Students must return to Great Oak High School in the same vehicle as they arrived. Coaches may release athletes, after a contest, to their guardians only if the athlete provides written permission from the guardian.  Meet there – Students will be asked to meet at the competition location when travel is outside of school hours.

11. Every athlete must sign a uniform agreement form at the beginning of the season. At the conclusion of the sports season, all school issued uniforms and equipment must be returned or the athlete will be subject to charges for replacement through the bookkeeper’s office. P a g e | 6

WARNING TO PARENTS: SERIOUS, CATASTROPHIC AND PERHAPS FATAL INJURY MAY RESULT FROM ATHLETIC PARTICIPATION

By its very nature, competitive athletics may put students in situations in which SERIOUS CATASTROPHIC and perhaps, FATAL ACCIDENTS may occur.

Many forms of athletic competition result in violent physical contact among players, the use of equipment which may result in accidents, strenuous physical exertion, and numerous other exposures to risk of injury.

Students and parents must assess the risks involved in such participation and make their choice to participate, in spite of the risks. No amount of instruction, precaution, or supervision will totally eliminate all risk of injury. Just as driving an automobile involves choice of risk; athletic participation by high school students also may be inherently dangerous. The obligation of parents and students in making this choice to participate cannot be overstated. There have been accidents resulting in death, paraplegia, quadriplegia, and other very serious permanent physical impairment as a result of athletic competition.

By granting permission for your student to participate in athletic competition, you, the parent or guardian, acknowledge that such risk exists.

Students will be instructed in proper techniques to be used in athletic competition and in proper utilization of all equipment worn or used in practice and competition. Students MUST adhere to that instruction and utilization and MUST refrain from improper uses and techniques.

As previously stated, no amount of instruction, precaution, and supervision will totally eliminate all risk of serious catastrophic or even fatal injury. If any of the foregoing is not completely understood, please contact your school principal for further information.

INSURANCE STATEMENT ***PLEASE READ ENTIRE STATEMENT CAREFULLY***

CALIFORNIA EDUCATION CODE SECTION 32221 REQUIRES THAT EVERY STUDENT OF AN ATHLETIC TEAM HAVE ACCIDENTAL BODILY INJURY INSURANCE, PROVIDING AT LEAST $1500 OF SCHEDULED MEDICAL AND HOSPITAL BENEFITS. IF YOU CANNOT AFFORD THIS MEDICAL COVERAGE FOR YOUR ATHLETE, THE ATHLETIC DEPARTMENT CAN ASSIST IN PROVIDING INFORMATION ON AN ACCIDENT POLICY, WHICH MEETS THE ABOVE REQUIREMENTS. THIS COVERAGE IS NOT A 24 HOUR MEDICAL POLICY. IT ONLY COVERS THE STUDENT WHILE PARTICIPATING IN A SCHOOL-SPONSORED AND SUPERVISED ATHLETIC ACTIVITY. I HAVE READ AND UNDERSTAND THE ABOVE INFORMATION REGARDING TVUSD’S POLICY. I UNDERSTAND THAT MAINTAINING THIS ACCIDENTAL BODILY INJURY INSURANCE POLICY IS MY RESPONSIBILITY AS THE PARENT OR GUARDIAN. IF, AT ANY TIME, DURING THE ATLETHIC SEASON I CAN NO LONGER AFFORD THIS POLICY IT IS MY RESPONSIBILITY TO CONTACT THE ATHLETIC DEPARTMENT.

BY SIGNING THIS DOCUMENT, I ACKNOWLEDGE THAT: 1. I have read the all of the above information and will abide by the provisions. 2 . All information provided is correct. False information will result in student ineligibility and team forfeits. 3. I will keep my insurance, in force, during the time my student tries out, practices or competes in athletics. 4. My student is enrolled or has an appointment to be enrolled in Great Oak High School P a g e | 7

CONCUSSION INFORMATION SHEET

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

Symptoms may include one or more of the following:  Headaches  Amnesia  “Pressure in head”  “Don’t feel right”  Nausea or vomiting  Fatigue or low energy  Neck pain  Sadness  Balance problems or dizziness  Nervousness or anxiety  Blurred, double, or fuzzy vision  Irritability  Sensitivity to light or noise  More emotional  Feeling sluggish or slowed down  Confusion  Feeling foggy or groggy  Concentration or memory problems (forgetting  Drowsiness game plays)  Change in sleep patterns  Repeating the same question/comment

Signs observed by teammates, parents and coaches include:  Appears dazed  Vacant facial expression  Confused about assignment  Forgets plays  Is unsure of game, score, or opponent  Moves clumsily or displays lack of coordination  Answers questions slowly  Slurred speech  Shows behavior or personality changes  Can’t recall events prior to hit  Can’t recall events after hit  Seizures or convulsions  Any change in typical behavior or personality  Loses consciousness P a g e | 8

What can happen if my child keeps on playing with a concussion or returns too soon?

Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recoveringfrom the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete’s safety.

If you think your child has suffered a concussion

Any athlete even suspected of suffering a concussion should be removed from the game or practice immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete should continue for several hours. The new CIF Bylaw 313 now requires implementation of long and well- established return to play concussion guidelines that have been recommended for several years:

“A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time and for the remainder of the day.” AND

“A student-athlete who has been removed may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and management of concussion and received written clearance to return to play from that health care provider”.

You should also inform your child’s coach if you think that your child may have a concussion Remember its better to miss one game than miss the whole season. And when in doubt, the athlete sits out.

For current and up-to-date information on concussions you can go to: http://www.cdc.gov/ConcussionInYouthsports P a g e | 9

ATHLETIC/ ACTIVITIES CONTRACT AGE AND RESIDENCE STATEMENT

My son/daughter will not compete on an outside team in the same sport during the high school season of that sport. STUDENT NAME AGE DATE OF BIRTH / / _ Gr. Grade ’17 – 18 School Year

Have you attended any OTHER High School? Yes No If yes, Name of School City, State

Dates Attended Previous School / to / Did you participate in varsity sports at another high school? Yes No Sport If you are entering Great Oak as a 10th, 11, or 12 Grade Athlete and you have previously attended another High School you must complete additional CIF transfer paperwork Code of Conduct and Academic Eligibility Requirements

As a condition of membership in the CIF, all schools shall adopt policies prohibiting the use and abuse of androgenic/anabolic steroids. All member schools shall have participating students and their parents, legal guardian/caregiver agree that the athlete will not use steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition (Article 524). I have read and understand the GOHS Wolf Pack Activities/Athletic Code of Conduct and Academic Eligibility Requirements. I understand that by signing this Contract, I agree to accept responsibility for violation of or noncompliance with the rules. By signing below, both the participating student athlete and the parents, legal guardian/caregiver hereby agree that the student shall not use androgenic/anabolic steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition. We recognize that under CIF Bylaw 200 D, there could be penalties for false or fraudulent information. We also understand that the Temecula Valley Unified School District/Great Oak High School policy regarding the use of illegal drugs will be enforced for any violations of these rules. These cumulative penalties and regulations, regarding any infractions of the Activities/Athletic Code, will be applied IN ADDITION TO and AFTER students have complied with the consequences of the regular school discipline program which include suspension and expulsion. These penalties are cumulative during a student’s tenure at GOHS.

Our signatures below will acknowledge that we understand and have read the following documents:

 TVUSD Activities/Athletic Code of Conduct  Athletic/Activities Academic Eligibility Requirements  Athletic/Activities Contract  CIF Code of Ethics  Age and Residence Statement  Warning to Athletes and Parents/Guardians  Insurance Statement  Concussion Information Sheet

STUDENT NAME (PRINT) STUDENT SIGNATURE DATE

PARENT/GUARDIAN NAME (PRINT) PARENT SIGNATURE DATE P a g e | 10

GREAT OAK HIGH SCHOOL ATHLETIC CLEARANCE VERIFICATION FORM PLEASE fill out BOTH FORMS PLEASE PRINT – Be sure to complete all information on this form STUDENT NAME AGE DATE OF BIRTH / / Grade ’17-18 LAST FIRST MI FALL WINTER SPRING Football, Cross Country, Volleyball, Boys/Girls Soccer, Wrestling, Baseball, Softball, Boys Golf, Track Girls Tennis, Boys’ Water Polo, Girls Boys/Girls Basketball, Girls Boys Tennis, Swimming, Boys/Girls Golf, Field Hockey, Water Polo, Cheer Squad, Dance Lacrosse, Boys’ Volleyball Cheer Squad, Dance Team, Team, Step Team Cheer Squad, Dance Team, Step Team Step Team (CIRCLE SPORT OF INTEREST) (CIRCLE SPORT OF INTEREST) (CIRCLE SPORT OF INTEREST)

Address: Birthdate / /

Parent/Guardian Name(s): _Cell #:

Mother’s Work Phone: Father’s Work Phone:

Email address: In the absence of parent/guardian, please call (in case of illness or accident):

Name: Relationship: Phone:

Name of Family Physician Phone ( )

CONSENT Yes No The student named above has my permission to engage in co-curricular activities, including travel.

TRAINER CONSENT Yes No I give my permission to the Athletic Trainer to administer immediate first-aid, follow-up treatment and rehabilitation when appropriate in his/her professional judgment and/or recommended by the consulting physician.

TREATMENT CONSENT Yes No In the event of accident or emergency, I (we) give permission for the school authorities to take my (our) child to any available doctor or hospital, or request their services. I (we) grant consent to any healthcare providers to provide my (our) child with any necessary medical care as a result of any injury or illness.

***IF YOUR ANSWER IS NO, PLEASE ADVISE THE SCHOOL AS TO WHAT ACTION YOU WOULD LIKE TAKEN

I/we hereby consent that in the event that I/we cannot be reached in an emergency, I/we hereby grant permission to physicians selected by the coaches and staff of the Temecula Valley Unified School District to secure proper treatment including hospitalization, injections, and/or anesthesia and surgery for the person named above. Any restrictions to this are listed below:

Parent/Guardian Signature Date P a g e | 11

GREAT OAK HIGH SCHOOL ATHLETIC CLEARANCE VERIFICATION FORM PLEASE fill out BOTH FORMS PLEASE PRINT – Be sure to complete all information on this form STUDENT NAME AGE DATE OF BIRTH / / Grade ’17-18 LAST FIRST MI FALL WINTER SPRING Football, Cross Country, Volleyball, Boys/Girls Soccer, Wrestling, Baseball, Softball, Boys Golf, Girls Tennis, Boys Water Polo, Girls Boys Girls Basketball, Girls Track, Boys Tennis, Swimming, Golf, Field Hockey, Cheer Squad, Water Polo, Cheer Squad , Pep Boys/Girls Lacrosse, Boys’ Dance Team,Step Team Squad, Dance Team, Step Team Volleyball Cheer Squad, Dance Team, (CIRCLE SPORT OF INTEREST) (CIRCLE SPORT OF INTEREST) Step Team (CIRCLE SPORT OF INTEREST) Address: Birthdate / /

Parent/Guardian Name(s): _Cell #:

Mother’s Work Phone: Father’s Work Phone:

Email Address: In the absence of parent/guardian, please call (in case of illness or accident):

Name: Relationship: Phone:

Name of Family Physician Phone ( )

CONSENT Yes No The student named above has my permission to engage in co-curricular activities, including travel.

***IF YOUR ANSWER IS NO, PLEASE ADVISE THE SCHOOL AS TO WHAT ACTION YOU WOULD LIKE TAKEN

Parent/Guardian Signature Date P a g e | 12

HOLD HARMLESS AND INDEMNIFICATION AGREEMENT

BETWEEN

TEMECULA VALLEY UNIFIED SCHOOL DISTRICT

AND

Name of Student/Participant

FOR PARTICIPATION IN Athletics/Activities/Clubs

Participation in the aforementioned activity is strictly voluntary. The student participant of the Sport/Activity mentioned above agree by virtue of their signature(s) (below) they will hereby agree to indemnify, defend, save and hold harmless the Temecula Valley Unified School District, its officers, agents, servants and employees, of and from all liability, claims, workers’ compensation claims, demands, debts, suits, actions and causes of action, including wrongful death, personal injury, person property and reasonable attorney fees for the defense thereof, arising out of or in any matter connected with the participation, performance or any act or deed under or pursuant to the terms and provisions of this agreement by such indemnifying party, or its officers, agents, servants and employees. This agreement remains in effect through June 30, 2018.

Additionally, the student/parent participant, by virtue of their signature below agrees to abide by the rules put forth in the Student Handbook and/or Board Policy regarding their student/participant behavior during the aforementioned Activity.

By: _

Student Name Student Signature

Parent Name Parent Signature

Date

P a g e | 13

Pursuing Victory with Honor CODE OF CONDUCT FOR PARENTS/GUARDIANS At Great Oak High School we believe in letting: * The players play * The coaches coach * The officials call the game We expect our parents and fans to cheer for our team, have fun, and save negative comments for somewhere else.

Athletic competition of interscholastic age children should be fun and should also be a significant part of a sound educational program. Everyone involved in sports Programs has a duty to assure that their programs impart important life skills and promote the development of good character. Essential elements of character building are embodied in the concept of sportsmanship and six core ethical values: trustworthiness, respect, fairness, caring, and good citizenship (the “Six Pillars of Character”). The highest potential of sports is achieved when all involved consciously Teach, Enforce, Advocate and Model (T.E.A.M,) these values and are committed to the ideal of pursuing victory with honor. Parents/guardians of student— athletes can and should play an important role and their good—faith efforts to honor the words and spirit of this Code can dramatically improve the quality of a child’s sports experience. Our athletic program subscribes to the Pursuing Victory With Honor Arizona Sports Summit Accord. “Pursuing Victory With Honor” and the “Six Pillars of Character”

TRUSTWORTHINESS  Trustworthiness—Be worthy of trust in all you do.  Integrity—Live up to high ideals of ethics and sportsmanship and encourage players to pursue victory with honor. Do what’s right even when it’s unpopular.  Honesty—Live honorably. Don’t lie, cheat, steal or engage in any other dishonest conduct.  Reliability—Fulfill commitments. Do what you say you will do.  Loyalty—Be loyal to the school and team; Put the interests of the team above your child’s personal glory. RESPECT  Respect—Treat all people with respect at all times and require the same of your student—athletes.  Class—Teach your child to live and play with class and be a good sport. He/she should be gracious in victory and accept defeat with dignity, compliment extraordinary performance and show sincere respect in pre-and post-game rituals.  Disrespectful Conduct—Don’t engage in disrespectful conduct of any sort including profanity, obscene gestures, offensive remarks of a sexual nature, trash-talking, taunting, boastful celebrations, or other actions that demean individuals or the sport.  Respect for Officials—Treat game officials with respect. Don’t complain or argue about calls or decisions during or after an athletic event. RESPONSIBILITY  Importance of Education—Support the concept of “Being a student first.” Commit your children to earning a diploma and getting the best possible education. Be honest with your child about the likelihood of getting an athletic scholarship or playing on a professional level. Reinforce the notion that many universities will not recruit student-athletes who do not have a serious commitment to their education. Be the lead contact for college and university coaches in the recruiting process.  Role Modeling—Remember, participation in sports is a privilege, not a right. Parents/Guardians too should represent the school, coach and teammates with honor, on and off the court/field. Consistently exhibit good character and conduct yourself as a positive role model.  Self-Control—Exercise self-control. Don’t fight or show excessive displays of anger or frustration.  Healthy Lifestyle—Promote to your child the avoidance of all illegal or unhealthy substances including alcohol, tobacco, drugs, and some over-the-counter nutritional supplements, as well as of unhealthy techniques to gain, lose, or maintain weight.  Integrity of the Game—Protect the integrity of the game. Don’t gamble or associate with gamblers.  Sexual Conduct—Sexual or romantic contact of any sort between students and adults involved with interscholastic athletics is improper and strictly forbidden. Report misconduct to the proper authorities. FAIRNESS  Fairness and Openness—Live up to high standards of fair play. Be open-minded, always willing to listen and learn. CARING  Caring Environment—Consistently demonstrate concern for student-athletes as individuals and encourage them to look out for one another and think and act as a team. CITIZENSHIP  Spirit of the Rules—Honor the spirit and the letter of rules. Teach your children to avoid temptations to gain competitive advantage through improper gamesmanship techniques that violate the highest traditions of sportsmanship. I have read and understand the requirements of this Code of Conduct and acknowledge that I may be excluded from events if I violate any of its provisions.

Parent/Guardian Signature Date

Parent/Guardian Signature Date P a g e | 14

***Per CIF & TVUSD Rules, this is the only form that can be used for athletic physicals*** Pre-participation Physical Evaluation History Form NOTE: This form is to be filled out by the patient and parent prior to seeing the physician DATE OF EXAM:

Name: Sex:_ Age: Date of Birth: Address: Phone: Grade: School: Sports: Personal Physician: Phone: In case of emergency, contact: Name: Relationship: Phone (H): (W):

Do you have any allergies? ‰ Yes ‰ No If yes, please identify specific allergy below. Medicines Pollens Food Stinging Insects _ Other Explain “Yes” answers below. Circle questions you don’t know the answers to.

GENERAL QUESTIONS Y N Do you have a bone, muscle, or joint injury that bothers you? Has a doctor ever denied or restricted your prescription in sports for any Do any of your joints become painful, swollen, feel warm, or look red? reason? Do you have any history of juvenile arthritis or connective tissue disease? Do you have any ongoing medical conditions? If so, please identify: MEDICAL QUESTIONS Y N ‰ Asthma ‰ Anemia ‰ Diabetes ‰ Infections Other: Do you cough, wheeze, or have difficulty breathing during or after exercise? Have you ever spent the night in the hospital? Have you ever used an inhaler or taken asthma medicine? Have you ever had surgery? Is there anyone in your family who has asthma? HEART HEALTH QUESTIONS ABOUT YOU Y N Were you born without or are you missing a kidney, an eye, a testicle Have you ever passed out or nearly passed out DURING or AFTER (males), your spleen, or any other organ? exercise? Do you have groin pain or a painful bulge or hernia in the groin area? Have you ever had discomfort, pain, tightness, or pressure in your chest Have you had infectious mononucleosis (mono) within the last month? during exercise? Do you have any rashes, pressure sores, or other skin problems? Does your heart ever race or skip beats (irregular beats) during exercise? Have you had a herpes or MRSA skin infection? Has a doctor ever told you that you have any heart problems? If so, Have you had a head injury or concussion? check all that apply: Have you ever had a hit or blow to the head that caused confusion, ‰ High blood pressure ‰ A Heart Murmur prolonged headache, or memory problems? ‰ High Cholesterol ‰ A Heart Infection Do you have a history of seizure disorder? ‰ Kawasaki Disease Other: Do you have headaches with exercise? Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, Have you ever had numbness, tingling, or weakness in your arms or legs echocardiogram) after being hit or falling? Do you get lightheaded or feel more short of breath than expected Have you ever become unable to move your arms or legs after being hit during exercise? or falling? Have you ever had an unexplained seizure? Have you ever become ill while exercising in the heat? Do you get tired more quickly than your friends do during exercise? Do you get frequent muscle cramps when exercising? Do you or someone in your family have sickle cell trait or disease? HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Y N Have you had any problems with your eyes or vision? Has any family member or relative died of heart problems or had an Have you had any eye injuries? unexpected or unexplained sudden death before age 50 (including Do you wear glasses or contact lenses? drowning, unexplained car accident, or sudden infant death syndrome)? Do you wear protective eyewear, such as goggles or a face shield? Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT Do you worry about your weight? syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic Are you trying to or has someone recommended that you gain or lose polymorphic ventricular tachycardia? weight? Are you on a special diet or do you avoid certain types of foods? Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator? Have you ever had an eating disorder? Has anyone in your family had unexplained fainting, unexplained Do you have any concerns that you would like to discuss with a doctor? seizures, or near drowning? FEMALES ONLY Y N BONE AND JOINT QUESTIONS Y N Have you ever had a menstrual period? Have you ever had an injury to a bone, muscle, ligament, or tendon that How old were you when you had your first menstrual period? caused you to miss practice or a game? How many periods have you had in the last 12 months? Have you ever had any broken or fractured bones or dislocated joints? Explain “Yes” Answers Here: Have you ever had an injury that required x MͲraRyI,sC, T scan, injections, therapy, a brace, a cast, or crutches? Have you ever had a stress fracture?

Have you ever been told that you have or have you had an x nͲreacyk fo instability or atlantoaxial instability? (Down syndrome or dwarfism) Do you regularly use a brace, orthotics, or other assistive device? 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 is granted for noncommercial purposes with acknowledgment. P a g e | 15

■ 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 a Heart • Murmurs (auscultation standing, supine, +/- Valsalva) • Location of point of maximal impulse (PMI) Pulses • Simultaneous femoral and radial pulses Lungs Abdomen b Genitourinary (males only) Skin • HSV, lesions suggestive of MRSA, tinea corporis c Neurologic 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 prepartcipation 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 (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 Societ y 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. HE0503 9- P a g e | 16

 Print Pages 9 – 15

 Take Page 14-15 to the Doctor with you and have them completed. Must have a Doctor’s Office Stamp  Bring Pages 9-15 to Athletic Office  Athletic Office will Stamp Approved and give one copy to The coach PRIOR TO TRYOUTS