eStem Public Charter School Coach's Handbook
ATHLETIC ENROLLMENT PACKET 2017-2018 Name: ___________________________________ Grade: ____________ Sport: _____________ Head Coach: ______________________ Please attach a copy of your most recent report card & a current physical. Physicals are only valid for 1 calendar year.
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
ATHLETICS TRANSPORTATION WAIVER Permission is granted for_______________________________to be transported by coaches, other parent(s)/ guardian(s) as indicated below while participating in (sport) _______________________ at eStem Public Charter School.
I authorize and allow my child to use the following mode(s) of transportation while participating in the school-sponsored activity shown above.
Ride in an eSTEM PCS vehicle driven by a
_______Initial here if
school district coach or advisor
authorized
Ride in a commercial vehicle driven by a
_______ Initial here if
licensed & insured commercial operator
authorized
Ride in a private vehicle driven by a
_______Initial here if
school district coach or advisor
authorized
Ride in a private vehicle driven by another
_______Initial here if
licensed & insured parent or guardian
authorized
By signing this document, I hereby expressly waive and release any and all rights and claims of any nature whatsoever I /we may have against the eSTEM Public Charter School, the Board of Education, and its members and employees, arising out of, in connection with or resulting from participation in the school activity listed above. Student Signature:_______________________________________
Date:_______
Parent/Guardian Signature: ________________________________
Date: _______
2
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
Athletics Waiver & Release Form Players Name: ______________________________________ Girl or Boy (please circle)
Sport___________________
Date of Birth: ______________ Grade______________
Parents Name: ___________________________________________________________________ Address: _________________________________ City: ____________________ Zip: __________ Phone (Home): _______________Parents Day # _______________Other Emer. #_____________ E-mail address: __________________________________________________________________
2017-2018 WAIVER & RELEASE In consideration for being permitted by eSTEM Public Charter School to participate in the above activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death or property damage which may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the EPCMS (its officers, employees, volunteers, and agents) from any participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of those risks is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity. PARENTAL CONSENT: (TO BE COMPLETED AND SIGNED BY PARENT/GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE). I hereby consent that my son/daughter ______________________, participate in the above activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity. I have carefully read this Agreement, Waiver, and Release and fully understand its contents. I am aware that this is a release of liability and a contract between me and EPCMS and I sign it of my own free will.
Signature ________________________________________________ Date ________________ Name Printed _____________________________________________
3
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
ATHLETIC PARTICIPATION FEE AGREEMENT Effective July 1, 2017 Parents and Student-Athletes, The eSTEM Athletic Department is constantly seeking to improve our service to our students, parents and supporters. Each year we aim to raise our level of excellence while maintaining our efforts to sustain a viable athletic program. As a part of those efforts, we are requiring that each student who elects to participate in athletics pay the eSTEM Athletic Participation Fee of $50. These funds will help foster our ability to provide a recognizable athletic department that is equipped to provide our students with our short and long term goals of a facility, transportation and the addition of extracurricular activities! This fee does not cover the cost of an athlete’s team shoes, required team gear or student athletes’ contributions to team fundraisers. Each student is still responsible for paying for his/her own shoes, replacing any damaged or missing uniform pieces, for participating in team fundraisers and any other costs deemed necessary by the head coach. Each team’s head coach will provide you with a deadline to submit the eSTEM Athletic Participation Fee that should be no later than the first day of competition. All payments should be submitted to the student’s head coach or to the Dean of Athletics. Checks should be made payable to eSTEM PCS. The memo line should say “Athletics Fee and the student-athlete’s name.” Any student that is eligible for the Free/Reduced Lunch program has an automatic waiver from paying the participation fee. If this applies, please notify the head coach of your waiver status immediately. Once confirmed by the school Registrar, the fee will be officially waived. Our goal is to get better and ultimately become a competitive force in the athletic community. We appreciate your continued support of eSTEM Athletics and our student-athletes. Thank you!
Rashard Sullivan Dean of Athletics, eStem Public Charter School
__________________________________________________ Please Detach and Return to the Dean of Athletics
Student – Athlete’s Name: _________________________________________ DATE: ________ SPORT: _________________________________________________________________ GRADE: ________ Amount Paid: $________ Payment Type: CASH________CHECK # __________ Money Order #________
4
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
Arkansas Activities Association Concussion Fact Sheet for Athletes and Parents WHAT IS A CONCUSSION A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a “ding”, “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious. Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost.
WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION? Observed by the Athlete • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Bothered by light • Bothered by noise • Feeling sluggish, hazy, foggy, or groggy • Difficulty paying attention • Memory Problems • Confusion • Does not “feel right”
WHAT TO DO IF SIGNS/SYMPTOMS OF A CONCUSSION ARE PRESENT Athlete • TELL YOUR COACH IMMEDIATELY • Inform parents • Seek medical attention • Give yourself time to recover Parent / Guardian • Seek medical attention • Keep your child out of play • Discuss play to return to play with coach • Address academic needs
Observed by the Parent / Guardian, Coach, or Teammate • Is confused about assignment or position • Forgets an instruction • Is unsure of game, score, or opponent • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows behavior or personality changes • Can’t recall events after hit or fall • Appears dazed or stunned
WHERE CAN I FIND OUT MORE INFORMATION? • Center for Disease Control www.cdc.gov/concussion/HeadUp/youth.html • NFHS Free Concussion Course http://nfhslearn.com/electiveDetail.aspx?courseID=15000 RETURN TO PLAY GUIDELINES 1. Remove immediately from activity when signs/symptoms are present. 2. Release from medical professional required for return (Neuropsychologist, MD, DO, Nurse Practitioner, Certified Athletic Trainer, or Physician Assistant) 3. Follow school district’s return to play guidelines and protocol SIGNATURES By signing below, I acknowledge that I have received and reviewed the attached AAA Concussion in Sports Fact Sheet for Athletes and Parents. I also acknowledge and I understand the risks of brain injuries associated with participation in school athletic activity.
__________________________ ____________________________ _________________ Athlete’s Signature Print Name Date __________________________ ____________________________ _________________ Parent’s Signature Print Name Date
5
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
eStem STUDENT-ATHLETE EMERGENCY CONTACT INFORMATION STUDENT’S NAME:
__________________________________
DATE OF BIRTH: AGE: MEDICAL CONDITIONS: ALLERGIES:
CURRENT MEDICATIONS: FAMILY DOCTOR: DOCTOR'S PHONE: PARENT'S / GUARDIAN NAME: HOME PHONE: WORK PHONE: CELL PHONE: ALTERNATE CONTACT'S NAME: HOME PHONE: WORK PHONE: CELL PHONE:
NOTES________________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________
6
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
ATHLETICS TRANSPORTATION WAIVER Permission is granted for_______________________________to be transported by coaches, other parent(s)/ guardian(s) as indicated below while participating in (sport) _______________________ at eStem Public Charter School.
I authorize and allow my child to use the following mode(s) of transportation while participating in the school-sponsored activity shown above.
Ride in an eSTEM PCS vehicle driven by a
_______Initial here if
school district coach or advisor
authorized
Ride in a commercial vehicle driven by a
_______ Initial here if
licensed & insured commercial operator
authorized
Ride in a private vehicle driven by a
_______Initial here if
school district coach or advisor
authorized
Ride in a private vehicle driven by another
_______Initial here if
licensed & insured parent or guardian
authorized
By signing this document, I hereby expressly waive and release any and all rights and claims of any nature whatsoever I /we may have against the eSTEM Public Charter School, the Board of Education, and its members and employees, arising out of, in connection with or resulting from participation in the school activity listed above. Student Signature:_______________________________________
Date:_______
Parent/Guardian Signature: ________________________________
Date: _______
2
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
Athletics Waiver & Release Form Players Name: ______________________________________ Girl or Boy (please circle)
Sport___________________
Date of Birth: ______________ Grade______________
Parents Name: ___________________________________________________________________ Address: _________________________________ City: ____________________ Zip: __________ Phone (Home): _______________Parents Day # _______________Other Emer. #_____________ E-mail address: __________________________________________________________________
2017-2018 WAIVER & RELEASE In consideration for being permitted by eSTEM Public Charter School to participate in the above activity, I hereby waive, release, and discharge any and all claims for damages for personal injury, death or property damage which may have, or which may hereafter accrue to me, as a result of participation in said activity. This release is intended to discharge in advance the EPCMS (its officers, employees, volunteers, and agents) from any participation in said activity, even though that liability may arise out of negligence or carelessness on the part of the persons or entities mentioned above. It is understood that this activity involves an element of risk and danger of accidents and knowing those risks I hereby assume those risks. It is further agreed that this waiver, release and assumption of those risks is to be binding on my heirs and assigns. I agree to indemnify and to hold the above person or entities free and harmless from any loss, liability, damage, cost or expense which they may incur as the result of my death or any injury or property damage that I may sustain while participating in said activity. PARENTAL CONSENT: (TO BE COMPLETED AND SIGNED BY PARENT/GUARDIAN IF APPLICANT IS UNDER 18 YEARS OF AGE). I hereby consent that my son/daughter ______________________, participate in the above activity, and I hereby execute the above Agreement, Waiver, and Release on his/her behalf. I state that said minor is physically able to participate in said activity. I hereby agree to indemnify and hold the persons and entities mentioned above free and harmless from any loss, liability, damage, cost, or expense which they may incur as a result of the death or any injury or property damage that said minor may sustain while participating in said activity. I have carefully read this Agreement, Waiver, and Release and fully understand its contents. I am aware that this is a release of liability and a contract between me and EPCMS and I sign it of my own free will.
Signature ________________________________________________ Date ________________ Name Printed _____________________________________________
3
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
ATHLETIC PARTICIPATION FEE AGREEMENT Effective July 1, 2017 Parents and Student-Athletes, The eSTEM Athletic Department is constantly seeking to improve our service to our students, parents and supporters. Each year we aim to raise our level of excellence while maintaining our efforts to sustain a viable athletic program. As a part of those efforts, we are requiring that each student who elects to participate in athletics pay the eSTEM Athletic Participation Fee of $50. These funds will help foster our ability to provide a recognizable athletic department that is equipped to provide our students with our short and long term goals of a facility, transportation and the addition of extracurricular activities! This fee does not cover the cost of an athlete’s team shoes, required team gear or student athletes’ contributions to team fundraisers. Each student is still responsible for paying for his/her own shoes, replacing any damaged or missing uniform pieces, for participating in team fundraisers and any other costs deemed necessary by the head coach. Each team’s head coach will provide you with a deadline to submit the eSTEM Athletic Participation Fee that should be no later than the first day of competition. All payments should be submitted to the student’s head coach or to the Dean of Athletics. Checks should be made payable to eSTEM PCS. The memo line should say “Athletics Fee and the student-athlete’s name.” Any student that is eligible for the Free/Reduced Lunch program has an automatic waiver from paying the participation fee. If this applies, please notify the head coach of your waiver status immediately. Once confirmed by the school Registrar, the fee will be officially waived. Our goal is to get better and ultimately become a competitive force in the athletic community. We appreciate your continued support of eSTEM Athletics and our student-athletes. Thank you!
Rashard Sullivan Dean of Athletics, eStem Public Charter School
__________________________________________________ Please Detach and Return to the Dean of Athletics
Student – Athlete’s Name: _________________________________________ DATE: ________ SPORT: _________________________________________________________________ GRADE: ________ Amount Paid: $________ Payment Type: CASH________CHECK # __________ Money Order #________
4
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
Arkansas Activities Association Concussion Fact Sheet for Athletes and Parents WHAT IS A CONCUSSION A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a “ding”, “getting your bell rung,” or what seems to be mild bump or blow to the head can be serious. Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost.
WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION? Observed by the Athlete • Headache or “pressure” in head • Nausea or vomiting • Balance problems or dizziness • Double or blurry vision • Bothered by light • Bothered by noise • Feeling sluggish, hazy, foggy, or groggy • Difficulty paying attention • Memory Problems • Confusion • Does not “feel right”
WHAT TO DO IF SIGNS/SYMPTOMS OF A CONCUSSION ARE PRESENT Athlete • TELL YOUR COACH IMMEDIATELY • Inform parents • Seek medical attention • Give yourself time to recover Parent / Guardian • Seek medical attention • Keep your child out of play • Discuss play to return to play with coach • Address academic needs
Observed by the Parent / Guardian, Coach, or Teammate • Is confused about assignment or position • Forgets an instruction • Is unsure of game, score, or opponent • Moves clumsily • Answers questions slowly • Loses consciousness (even briefly) • Shows behavior or personality changes • Can’t recall events after hit or fall • Appears dazed or stunned
WHERE CAN I FIND OUT MORE INFORMATION? • Center for Disease Control www.cdc.gov/concussion/HeadUp/youth.html • NFHS Free Concussion Course http://nfhslearn.com/electiveDetail.aspx?courseID=15000 RETURN TO PLAY GUIDELINES 1. Remove immediately from activity when signs/symptoms are present. 2. Release from medical professional required for return (Neuropsychologist, MD, DO, Nurse Practitioner, Certified Athletic Trainer, or Physician Assistant) 3. Follow school district’s return to play guidelines and protocol SIGNATURES By signing below, I acknowledge that I have received and reviewed the attached AAA Concussion in Sports Fact Sheet for Athletes and Parents. I also acknowledge and I understand the risks of brain injuries associated with participation in school athletic activity.
__________________________ ____________________________ _________________ Athlete’s Signature Print Name Date __________________________ ____________________________ _________________ Parent’s Signature Print Name Date
5
[ESTEM PUBLIC CHARTER SCHOOL COACH’S HANDBOOK]
2017-2018
eStem STUDENT-ATHLETE EMERGENCY CONTACT INFORMATION STUDENT’S NAME:
__________________________________
DATE OF BIRTH: AGE: MEDICAL CONDITIONS: ALLERGIES:
CURRENT MEDICATIONS: FAMILY DOCTOR: DOCTOR'S PHONE: PARENT'S / GUARDIAN NAME: HOME PHONE: WORK PHONE: CELL PHONE: ALTERNATE CONTACT'S NAME: HOME PHONE: WORK PHONE: CELL PHONE:
NOTES________________________________________________________________________
______________________________________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ _____________________________________________________________________________
6
