Source: http://parkridge.powermediallc.org/forms/sports-permission-packet/
Timestamp: 2018-12-17 15:34:21
Document Index: 165878380

Matched Legal Cases: ['art 1', 'art 2', 'art 3', 'art 4', 'art 5', 'art 6']

Sports Permission Packet | Park Ridge Athletics
Part 1- Code of Conduct
Your son/daughter has requested the privilege of taking part in our athletic program. Before he/she may take part, it is necessary for us to have your consent by completing the form below.
I will be happy to try to answer any questions you might have regarding the PRHS Athletic Program. You may call me at the high school, (201) 573-6000 ext. 5610, or write me in care of the school.
Student-Athlete's Name*
Student-Athlete Phone*
Please click both confirming your have read the Park Ridge Code of Conduct.
We have read and understand the Athletic Code of Conduct and the Student/Parental Permission form of Park Ridge High School.
We also understand that participation in interscholastic athletics involves an element of danger and risk of personal injury, and we have chosen to participate with that awareness in mind.
By clicking this box, I attest to my understanding and concurrence with the information presented on this page.
Part 2- NJSIAA Steroid Testing Policy Consent To Random Testing
Please click both confirming your have read the NJSIAA Steroid Testing Policy Consent To Random Testing (above) and the List of Banned Substances*
I have read the NJSIAA Steroid Testing Policy
By clicking this box, both student/athlete and parent/guardian attest to our understanding and concurrence with the information presented on this page.
Part 3- NJSIAA Concussion Policy Acknowledgement Form
NJSIAA has mandated that the parents/guardians of a student-athlete who participates in interscholastic athletics receive on an annual basis, per year the student athlete participates, a concussion information sheet. The student-athlete and their parents/guardians shall sign acknowledging that they have received a copy of the informational sheet, in addition to the already required pre-participation examination forms. Failure to comply with this provision shall preclude the student-athlete from participating in athletics related to the desired sport.
Please click both confirming your have read the NJSIAA Parent/Guardian Concussion Policy Acknowledgment Form.*
I have read the NJSIAA Parent/Guardian Concussion Policy Acknowledgment Form
Part 4- IMPACT Permission
Park Ridge High School utilizes an innovative concussion management program for our student athletes. The program is called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) and involves an online, computerized exam that the athlete takes prior to the athletic season. All student athletes are required to take the baseline test on a home computer or school computer.
If the athlete is believed to have suffered a concussion during athletic participation, the exam is taken again and the data is compared to the baseline test. This information is then used as a tool to assist the athletic trainer and treating physicians in determining the extent of the injury, monitoring recovery, and in making safe return to play decisions. If an injury of this nature occurs, we will be in contact with you. Post-concussion test will be taken under our supervision at school.
Founded by the University of Pittsburgh Medical Center’s Sports Concussion program, this software system is fast becoming the “Gold Standard” in recognizing and managing head injuries. The program is used by countless colleges and high schools across the country, as well as in professional and Olympic sports such as: the NFL, NHL, and the US Soccer teams. General information about the test can be found at: www.impacttest.com.
The exam takes about 25-30 minutes and is non-invasive. The program is basically set-up in a (video game) type format. It tracks neuro-cognitive information such as memory, reaction time, brain processing speed, and concentration.
One of the reasons concussions are so dangerous is a condition called Second Impact Syndrome. If an athlete sustains a second concussion before completely recovering from the first, the results can be deadly. At Park Ridge, we understand the competitive nature of sports, but we always hold the athlete’s health and safety as our top priority.
The baseline test is not intended to identify a present concussion. Students who have suffered a recent concussion or have not recovered from a concussion should not take the ImPACT baseline test. Instead please notify the Athletic Trainer immediately for an injury evaluation. In addition, athletes who are experiencing fatigue, physical illness, or an injury should postpone the test until feeling better.
Please sign and return the bottom portion of this form indicating that your son/daughter has taken the test. If you do not have access to a home computer, please contact our Athletic Trainer at 201-573-6000 ext. 5602.
Impact Attestation*
I have read and understood the above information and give permission for my son/daughter to participate in the ImPACT Concussion Management Program. I also agree to ensure a valid test by following the guidelines provided by ImPACT
Part 5- Sudden Cardiac Death In Young Athletes
Governor Christie signed the Scholastic Student-Athlete Safety Act (P.L. 2013, c.71) on June 27, 2013, effective November 1, 2013. The intent of the Act is to establish measures to ensure the health of student athletes in public and nonpublic schools including:
• Use of a “Preparticipation Physical Evaluation” (PPE) form developed jointly by designated organizations;
• Development of a professional development module to increase the assessment skills of those health care practitioners who perform the student athlete physical examinations;
• Certification by the health care practitioner, who completes the PPE, and the school physician who reviews and approves the PPE that they have completed the module;
• Inclusion of a statement of assurance in the contract between the school district and the school physician that the school physician has completed the module; and
• Distribution of a pamphlet about sudden cardiac arrest provided by the New Jersey Department of Education (NJDOE) to parents of student athletes and receipt of a written certification from parents that they received and reviewed the pamphlet
Please click confirming your have read the Sudden Cardiac Death In Young Athletes Phamphlet.*
I have read the Sudden Cardiac Death In Young Athletes Phamphlet
Part 6- Emergency Information Card
Please complete the required emergency information card. In order to participate with an athletic team, each student-athlete must submit this completed form before the first practice.
Relevant Past Medical History*
Home Phone (with area code)*
Cell Phone (with area code)*
Please click confirming your have read the Student/Athletic Accident Insurance for the 2018-2019 school year.*
I have read the Student/Athletic Accident Insurance
I declare that my signature below signifies my understanding and concurrence with the information completed in the Sports Permission Packet, which includes:
- Steroid Consent Form
- Impact Permission
- Opioid Use and Misuse Face Sheet
- Emergency Information Card
I declare to my understanding and concurrence with the information completed in the Sports Persmission Packet, which includes: Code of Conduct, Steroid Testing Policy, Concussion Policy, Impact Permission, Sudden Cardiac Death In Young Athletes, Opioid Use and Misuse Face Sheet and Emergency Information Card.
Student/Athlete Signature*