Battle Ground School District Statement of Compliance with Youth Sports Head Injury and Sudden Cardiac Arrest Requirements

_______________________ (name of organization) request the use of Battle Ground School District Facilities for the following dates: ____________________________ _______________________ (name of organization) has provided to our coaches all training that is available to the organization and provided by WIAA or CDC on head injuries and concussions. _______________________ (name of organization) has provided to our coaches all training that is available to the organization and provided by WIAA or NFHS on sudden cardiac arrest. _______________________ (name of organization) will fully comply with all of the requirements, Policies, and guidelines issued by the WIAA related to head injury and concussion and sudden cardiac arrest. (For more information please see WIAA.com) Below is a list of the name of the material or presentation that has been provided to coaches in our Organization, persons who attended or were otherwise given the materials, and the date presented/given. The organization will make available upon request by the district documentation of training provided during the course of the facility use agreement which has occurred after the signing of this Statement of Compliance. Training/Material or Presentation

Name of Person Presenting

Date

___________________________

____________________________

___________

___________________________

____________________________

___________

___________________________

____________________________

___________

Attached is proof of insurance under an accident and liability policy issued by an insurance company authorized to do business in Washington State covering any injury or damage with at least $1,000,000 due to bodily injury or death to one person and at least $1,000,000 due to bodily injury or death to each additional persons. At Battle Ground School District facilities, all parties are prohibited from discrimination against any person on the basis of sex; in the operation, conduct, or administration of community athletic programs for youth or adults.

Signed:

____________________________________________________________ Representative of Private, Non-Profit Youth Sports Group

Date:

________________________

NOTE: ACCESS TO SCHOOL FACILITIES/FIELDS MAY NOT BE GRANTED UNTIL ALL REQUIREMENTS OF THIS APPLICATION ARE COMPLETE AND APPROVED BY THE SCHOOL DISTRICT AND/OR DESIGNEE. The Battle Ground Public Schools provides equal opportunity in programs and employment and does not discriminate on the basis of race, color, national origin/language, creed/religion, sex, sexual orientation including gender identity, disability, or the use of a service animal by a person with a disability, age, marital status, honorably discharged veteran or military status, HIV/Hepatitis C status. The district provides equal access to the Boy Scouts and other designated youth groups. Contact the following regarding questions and complaints of alleged discrimination: Title IX Compliance Officer, 360.885.5481; Title IX Athletic Coordinator 360.885.5415; Section 504/ADA Coordinator 360.885.5481; Compliance Coordinator for State Civil Rights Laws, 360.885.5415; or a letter may be submitted to the designated coordinator at the Battle Ground Public Schools, PO Box 200, Battle Ground, WA 98604. 9/29/15