2016-2017 ATHLETICS/ACTIVITIES ELIGIBILITY PACKET



All information must be COMPLETE to participate co-curricular activities, including practice and games. Form Name 1. Concussion Information Form……………………………………………………………………………….……..pg. 5-6 2. Warning/Agreement to Obey Instructions……………………….………………………………………………pg. 7 3. Safety Guidelines……………………………………………………………………………………………………………..pg. 8 4. Medical Information and Registration Form…………………………………………………………………….pg. 9 5. Parental Consent for 2016-2017 School Year Athletics/Activities…………………………………..pg. 10 6. Optional: Winthrop Physical Therapy Permission to Treat Form…………………….……………..pg. 11 7. Up-to-Date Sports Physical for athletic activities. Physicals are valid for 24 months.







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EXTRA-CURRICULAR HONOR CODE

Participation in any Methow Valley School District’s interscholastic activities is completely voluntary. These opportunities are made available to all Methow Valley School District students regardless of gender race or national origin. Involvement in these programs requires extra effort and extra time on a voluntary basis beyond the regular school day. Although participation in interscholastic activities is voluntary, those participating do represent the student body and community. Therefore, standards including academic requirements, citizenship, sportsmanship, conduct (discipline and appropriate behavior), conditioning, and loyalty must be maintained at a higher level than for non-participants. School programs should reflect the attitude of the community that pays for them. If appropriate benefits are to be derived from co-curricular programs, they must be able to operate in a climate devoid of disruptive influences. If the community is to truly identify with its schools through the co-curricular medium, it is imperative that participants conduct themselves in a manner that will inspire pride and approval.

Attendance MVSD and WIAA rules require that: 1. Student-athletes must fully attend all classes on the day of any activity and/or practice in order to participate that day, unless given approval by the Principal or Activities Director or unless the absence is excused. Additionally, student-athletes returning home late from activities are expected to attend all classes the following day. Failure to do so could impact participation in following games. 2. Students that go home sick may not return later in the day for games or practice. 3. Student-athletes must be in attendance for the full day on Friday, to participate in an activity during the weekend, unless given approval by the Principal or Activities Director or unless the absence is excused. 4. The following absences are excused: Family events with a planned absence form turned in ahead of time. Other planned absences with the form turned in ahead of time. Medical appointments, family emergencies (ex. death in family), mechanical/transportation issues, school sponsored activities and out-of-school suspensions. 5. The following absences are not excused: Family events without a planned absence form turned in ahead of time. Other planned absences without the form turned in ahead of time. Parent/guardian permission for any reason besides listed under excused absences. 6. On dates of events, students shall remain in class until the “official release time”. Leaving prior to the release time will be considered as an unexcused absence, thus students will not be eligible for the contest/practice since they did not fully attend all classes. If the absence is not reported until after the contest, the student-athlete will be ineligible for the ensuing contest.

Grades MVSD and WIAA rules require that: Standard I: The student must be passing all of his/her classes on the previous semester transcript. A student who does not meet this requirement shall be ineligible for competition for the first two weeks of the sport/activity season. If semester grades are released during a sports season, a student who is not passing all classes will be ineligible for two weeks of competition starting when grades are officially posted. Ineligible students are still expected to attend practice.

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Standard II: In addition, the student must be passing all of her/his classes in the current semester. Each Monday, or first day of the school week, there will be a grade check. Any student identified as not passing any of her/his classes, will be declared ineligible until they are meeting standard in all classes. Ineligible students will be given an “NC slip” to indicate which classes they are not passing. The “NC slip” must be signed off by teachers and turned into the player’s coach before they can be eligible for competition. Ineligible students are still expected to attend practice.

Sportsmanship Sportsmanship is defined as observing rules of fair play and acceptable interaction with others. You should treat others as you would wish to be treated. This includes demonstrating the qualities of courtesy, fairness and respectfulness to officials, teammates, opponents, coaches and all others associated with the activity. Unsportsmanlike conduct will result in disciplinary consequences, such as probation, suspension, or dismissal from athletic/activity participation. When an infraction occurs, the consequences shall be the decision of the Coach, Activities Director, and Principal.

Traveling to and from Activities The following rules apply to participants in school-sponsored activities when traveling to/from events. 1. All participants shall travel to and from co-curricular events in transportation provided by the school district; and shall be dropped off at approved MVSD bus stops. (Liberty Bell, Carlton Store, Hank’s Market, Loup Loup Summit, Red Barn in Winthrop, Hwy 20 at Goat Creek Rd.) 2. Participants may be released to a parent for transportation from an interscholastic contest, if the parent provides a written notification to the head coach. If possible, any parent intending to do this is requested to let the head coach know before the day of the event. 3. If a student is going to ride with a non-parent/guardian, the appropriate paperwork must be completed and on file with the Activities Director before the student leaves for the activity. There is a “permission to ride with another adult form” available on our school website, methow.org, under athletics. 4. Conduct on the bus will be governed by school district bus rules and those established by the head coach and the transportation department. If an incident arises and the transportation department or school cannot be contacted, the bus driver has ultimate authority. 5. On trips, participants will remain with the squad and under the head coach’s supervision at all times. 6. On longer trips, the bus may stop for a short rest at the discretion of the bus driver and head coach. The head coach is responsible for supervision.

Standard Application of Sanctions All students who choose to participate in the co-curricular programs of MVSD will comply with the rules and regulations and will be subject to the reasonable discipline of school authorities. The honor code will be in effect yearly, from the first day of Fall turnout, until the last day of school; except for criminal misconduct proven guilty by a court of law, which is in effect year round. Any student who willfully performs an act, which interferes with, or is detrimental to the orderly operation of a school’s education and extra-curricular program will be subject to co-curricular discipline. The following acts by a student on school premises or at any school sponsored activity will constitute sufficient cause for extra-curricular discipline, probation, suspension or expulsion: disruptive conduct or disobedience of reasonable instruction by school authorities or teachers; refusal to identify oneself;

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unauthorized absence from school or activity; cheating; immoral conduct; vulgarity or profanity; destruction or defacing of property. The following acts by a student will constitute sufficient cause for use of the sanctions outlined below: Extortion; intimidation or harassment (including racial/gender) of a student or employee; assault of another student or employee; stealing; possession or use of any dangerous weapons or objects; and the commission of any criminal acts as defined by law. Use, sale or possession of tobacco; use, sale or possession of alcoholic beverages; use, sale or possession of drugs and/or related paraphernalia. First Offense: The student-participant will be ineligible to participate in 25% of scheduled games or performances. This can carry over to succeeding seasons. She/he must participate in practices. Second Offense: The student-participant will be ineligible to participate in games/performances for a total of 50% of scheduled games or performances. This can carry over to succeeding seasons. She/he must participate in practices. Third Offense: The student-participant will be ineligible to participate in games/performances for a total of 100% of a season. This will begin in the current season and may extend into the next season in which the participant is involved. She/he must participate in practices. Fourth Offense: A student athlete who violates for a fourth time will be permanently prohibited from participation in any WIAA member school extra-curricular program.

Honesty and Jubilee Date Provisions The consequences for the above offenses will be reduced by 50% (with the exception of the Fourth Offense) if the student and her/his parents/guardians voluntarily make the first report of the violation to administration. In cases of the above offenses, a jubilee can be given, if earned. This means if the student-participant has no infractions of the Honor Code for two years, the consequence does not increase in level.

Handbook Case Scenarios: Q: My student has a dentist appointment during the day of his/her basketball game. Will he/she be able to participate in the game? A: Yes. A medical appointment is an excused absence as long as the school is notified. Q: My student arrived at school more than twenty minutes late this morning because he/she could not get out of bed, will he/she be allowed to practice or play in a game? A: No. Students must fully attend all classes to participate, and this is not an excused absence. Q: My student left school at lunch because they were feeling ill. After spending some time at home he/she is feeling better. May he/she practice or compete in a game tonight? A: No. Once a student misses classes due to illness, they are ineligible for practice or contests that night, even if they return to school for the final period.

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Q: My student did not attend class until after lunch due to illness. Can he/she participate in evening activities? A: No. Q: My student has recently transferred into (or back into) the school district. Are they automatically eligible for competition? A: No. There are complicated WIAA rules around this. See the athletic director to work through the student’s eligibility. Q: My student had a family emergency during the day of a game. Can he/she still participate in the game and/or practice? A: Yes. A family emergency is an acceptable absence as long as the absence is excused with the office. Q: My student violated an honor code policy during the summer, with this impact their athletic participation? A: No, not unless there was criminal misconduct proven guilty by a court of law. In which case school officials will determine the best course of action.



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CONCUSSION INFORMATION FORM

A concussion is a brain injury and all brain injuries are serious. It is 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. A concussion 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. One cannot see a concussion and most sports concussions occur without loss of consciousness, and signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. If your student 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: • Amnesia • Headaches • "I don't feel right" • "Pressure in head" • Fatigue or low energy • Nausea or vomiting • Sadness • Neck pain • Nervousness or anxiety • Balance problems or dizziness • Irritability • Blurred, double, or fuzzy vision • More emotional confusion • Sensitivity to light or noise • Concentration or memory problems • Sluggish or slowed down activity (forgetting game plays) • Foggy or groggy behavior • Repeating the same question/comment • Drowsiness • Change in sleep patterns 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 incoordination 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

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 6/15/2009



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What can happen if my student 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 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 recovering from 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 athletes will often fail to report symptoms of injuries. Concussions are no different. As a result, education of administrators, coaches, parents and students is the key to a studentathlete's safety. If you think your student 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 “Zackery Lystedt Law” in Washington now requires the consistent and uniform implementation of long and well-established return to play concussion guidelines that have been recommended for several years: “A youth 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 “…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 student’s coach if you think that your student may have a concussion. Remember it’s 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/ Student/Athlete Name Printed

Student/Athlete Signature

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Parent/Legal Guardian Name Printed

Parent/Legal Guardian Signature

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THIS FORM MUST BE COMPLETELLY FILLED OUT AND RETURNED TO THE METHOW VALLEY SCHOOL DISTRICT BEFORE YOUR STUDENT/ATHLETE CAN PARTICIPATE IN ANY EXTRA-CURRICULAR ACTIVITIES

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 6/15/2009 Eligibility Packet 6



SPORTS WARNING/AGREEMENT TO OBEY INSTRUCTIONS (Prior to participating, both the student and parent must ready carefully and sign.)

Select the sport(s) you intend to participate in during the 2016-2017 school year: ! Baseball ! Basketball ! Cheer ! Cross Country ! Football ! Soccer ! Softball ! Tennis ! Track & Field ! Volleyball ! Wrestling ! Knowledge Bowl I am aware that the sports/activities listed above contain risks and that practicing or competing in any of them could be a dangerous activity involving MANY RISKS OF INJURY. I understand the dangers and risks of practicing and competing in any of these sports include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of the musculoskeletal system, and serious injury of impairment to other aspects of the body, general health and well-being. I understand that the dangers and risks of practicing or competing in any of the sports listed above may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities and generally to enjoy life. I also understand that the sport in which I participate may be so inherently dangerous that no amount of reasonable supervision, protective equipment or training can eliminate all vestiges of danger. I am informed the District does not assume the responsibility for the medical services required for these risks. Because of the dangers of the sports offered at Liberty Bell, I recognize the importance of following the coaches’ instruction regarding techniques, training and other team rules, etc., and to agree to obey such instructions In consideration of the Methow Valley School District permitting me to try out for any 2016-2017 school sponsored sports team and to engage in all activities related to the team, including but not limited to trying out, practicing or competing in any school sponsored sport, I have read the above warnings and I understand their terms. Student/Athlete Name Printed

Student/Athlete Signature

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Parent/Legal Guardian Name Printed

Parent/Legal Guardian Signature

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FOOTBALL ONLY I, ______________________, am the parent/guardian of ___________________________________. In consideration of the Methow Valley School District permitting my student/ward for the 2016-2017 school football team and to engage in all activities related to the team, including, but not limited to, practicing or competing in football, I have read the above warning and I understand their terms. _________________________________ _______________________________ _______________ Parent/Legal Guardian Name Printed



Parent/Legal Guardian Signature

Date

THIS FORM MUST BE COMPLETELLY FILLED OUT AND RETURNED TO THE METHOW VALLEY SCHOOL DISTRICT BEFORE YOUR STUDENT/ATHLETE CAN PARTICIPATE IN ANY EXTRA-CURRICULAR ACTIVITIES

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SPORTS SAFETY GUIDELINES (Prior to participating, both the student and parent must ready carefully and sign.)

When a person is involved in any athletic activity, an injury can occur. All school-sponsored sports are highly competitive, can be fast-paced, and may place great physical demands on the players. One should be aware the information presented in these safety guidelines is to inform the athlete of proper techniques and inherent dangers involved with any particular sport. There is a chance of broken bones, severe concussions, and back injuries, which could lead to some form of paralysis. Not all potential injury possibilities in school-sponsored sports are listed, but athletes should be aware that fundamentals, coaching and proper-fitting equipment are important to safety and enjoyment of the sport.



1. Proper warm-up is essential before strenuous activity takes place. 2. Clothing and shoes should fit properly, be comfortable and allow maximum physical effort and dissipation of heat. 3. Perform only those skills and techniques as instructed and/or supervised by your coach. 4. Travel to and from off-campus facilities and practice/competition sites must be in accordance with school procedures. 5. Be aware of throwing or hitting a ball from other parts of the gym. 6. Be aware of your surroundings both home and away including but not limited to proximity of bleachers and courtside obstructions such as basket supports, lighting, access to and from courts, and court surfacing. 7. Be especially aware of the danger of illegal actions such as undercutting another player or grasping/hanging on the rim. 8. Players whose vision requires correction must wear shatterproof glasses or lenses. Glasses must be mounted in break-resistant frames and must be held in place by an elastic strap. 9. Remove all jewelry and metal hair fasteners and other body adornments as required by rules and regulations for the sport you are participating in.

10. Make sure you drink adequate water to prevent dehydration; ask your coach for consumption guidelines bases on the day’s activity. 11. Notify the coach immediately if injured.



The above information has been explained to me and I understand the list of rules and procedures. I also understand the necessity of using the proper techniques while participating in any school sponsored sports program. Student/Athlete Name Printed

Student/Athlete Signature

Date

Parent/Legal Guardian Name Printed

Parent/Legal Guardian Signature

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THIS FORM MUST BE COMPLETELLY FILLED OUT AND RETURNED TO THE METHOW VALLEY SCHOOL DISTRICT BEFORE YOUR STUDENT/ATHLETE CAN PARTICIPATE IN ANY EXTRA-CURRICULAR ACTIVITIES

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Student/Athlete Information

Student/Athlete Name: _________________________________________________________

Sex: !Male !Female Birth date:____________ Grade:__________ Cell #:_______________ Address where student resides:_________________________________________________________ School: !LB Jr./Sr. High !ILC !Running Start !Home School !Other__________________ Has student been registered with another school district within the past 12 months? !No !Yes

Parent/Guardian Information Parent/Guardian Name:______________________________________________________________ Address:___________________________________________________________________________ City:____________________________________ State:___________ Postal Zip:______________ Home #:____________________ Work #:___________________ Cell #:____________________ E-mail Address:_____________________________________________________________________

Insurance Information Medical Insurance Company:_____________________________ Policy #:____________________ Dental Insurance Company:______________________________ Policy #:____________________

Other Emergency Contact Name/Relation: ____________________________________________ Phone #:_________________

Medical Information My Student has allergies: !No !Yes (if “yes” please list below) Allergies:____________________________________________________________________________ My Student has a history of concussions: !No !Yes (if “yes” please describe number and severity) Concussions:_________________________________________________________________________ ___________________________________________________________________________________ ___________________________________________________________________________________

ATHLETIC/ACTIVITY REGISTRATION FORM Methow Valley School District Authorization for Emergency Medical/Dental Treatment

I authorize the Principal or their designee to transport and seek emergency medical or dental treatment when the need for such treatment is immediate and when efforts to contact me are unsuccessful. I understand the Methow Valley School District, its employees and its Board of Directors assume no liability of any nature in relationship to the transportation or treatment of the said minor. I further understand that all costs of EMS transportation, hospitalization, examination, x-ray or treatment provided in relation to this authorization shall be my responsibility. This authorization shall remain effective for the full school year unless revoked in writing and delivered to the Methow Valley School District.

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Parent/Legal Guardian Name Printed

Parent/Legal Guardian Signature

Date



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PARENTAL CONSENT FOR 2016-2017 SCHOOL YEAR ATHLETICS/ACTIVITIES

We (parent/athlete/participant) have read and have full acknowledgement of information listed in the: 1. Extra-Curricular Honor Code 2. Concussion Information Form 3. Warning/Agreement to Obey Instructions 4. Safety Guidelines I have read the expectations and guidelines and agree to the rules of participation in the above. We hereby give our consent for our son/daughter to engage in interscholastic athletics/activities provided by the Methow Valley School District

ASB/PER ACTIVITY FEES AND SPORTS UNIFORMS The $50.00 ASB Card and $45.00 Per Activity Fee must be paid in full before the first game in order to participate. Uniforms must be returned clean at the end of the season. If your uniform is not returned, you will be fined up to $200.00 for replacement. You will not be issued new uniforms until previous uniforms are returned or paid for. Student/Athlete Name Printed

Student/Athlete Signature

Date

Parent/Legal Guardian Name Printed

Parent/Legal Guardian Signature

Date



THIS FORM MUST BE COMPLETELLY FILLED OUT AND RETURNED TO THE METHOW VALLEY SCHOOL DISTRICT BEFORE YOUR STUDENT/ATHLETE CAN PARTICIPATE IN ANY EXTRA-CURRICULAR ACTIVITIES YOUR STUDENT/ATHLETE IS ALSO REQUIRED TO HAVE A VALID PHYSICAL ON FILE WITH THE SCHOOL. PHYSICALS ARE VALID FOR ONE CALENDAR YEAR PER MVSD POLICY. FOR QUESTIONS ON THE STATUS OF YOUR STUDENT/ATHLETE’S PHYSICAL, PLEASE CONTACT THE ATHLETIC OFFICE.

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Date: _______________________________



I, ______________________________________, give Winthrop Physical Therapy permission to treat my son/daughter____________________________________ for physical therapy conditions as needed according to their professional discretion. Winthrop Physical Therapy often provides student injury screenings free of charge. This waiver gives us permission to screen your child’s injury even if you are unable to be present for their visit. Injuries don’t always happen at times that are convenient for parents to bring their children in personally. You would be notified if your child’s injury requires additional physical therapy attention beyond a free screening. _____________________________________ Parent Signature



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