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STUDENT INFORMATION:
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PARENT/GUARDIAN INFORMATION
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AUTHORIZED PERSON TO CONTACT IN CASE OF AN EMERGENCY
I.E.- Grandfather, Grandmother, family friend
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PRIMARY CARE DOCTOR INFORMATION
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STUDENT/ATHLETE HEAD INJURY HISTORY
Pursuant to Massachusetts General Law, Chapter 111, Section 222, participants of interscholastic athletic programs and their parents prior to each season must disclose any information relative to any sports head injury history. this information must be shared with the athlete's coach(s) and a copy will be kept on file in the offices of the Director of Athletics and the School Nurse.
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Have you every exhibited signs, symptoms or behaviors consistent with a concussion (such as loss of consciousness, headache, dizziness, confusion, or balance problems) during a sporting competition at any level?
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Have you ever been diagnosed with a concussion?
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Do you currently have or have you ever had athletic participation restrictions in relation to being diagnosed with a concussion?
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STATE LAW REGARDING SPORTS-RELATED INJURY AND CONCUSSIONS
The commonwealth of Massachusetts Executive Office of Health and Human Services now require that all schools subject to the Massachusetts Interscholastic Athletic Association (MIAA) rules adhere to the following law. (These rules, specific to head injury, will govern Wareham Senior High.) Student-athletes and their parents, coaches, athletic directors, school nurses, and physicians must learn about the consequences of head injuries and concussions through training programs and written materials. The law requires that athletes and their parents inform their coaches about prior head injuries at the beginning of the season. If a student athlete becomes unconscious during a game or practice, the law now mandates taking the student out of play or practice, and requires written certification from a licensed medical professional for “return to play”.
Parents and students who plan to participate in any athletic program representing Wareham Senior High must also take a free on-line course. Two free on-line courses are available and contain all the information required by law. The first is available through the National Federation of High School Coaches. You will need to click the “order here” button and complete a brief information form to register. At the end of the course, you will receive a completion certificate. The entire course, including registration, can be completed in less than 30 minutes.
http://www.nfhslearn.com/electiveDetail.aspx?courseID=15000
The second on-line course is available through the Centers for Disease Control and Prevention at:
www.cdc.gov/Concussion
The Oakmont/Overlook Athletic Department will also provide student-athletes and their parents, a concussion education presentation. This presentation will take place as part of our “Parent Night” held before each of our three sports seasons; and conducted by one of our local medical professionals.
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WAREHAM ATHLETE PARTICIPATION ANTI-HAZING LAW Commonwealth of Massachusetts: Anti-Hazing Law Chapter 269: Section 17. Hazing; organizing or participating; hazing defined:
Whoever is a principal organizer or participant in the crime of hazing, as defined herein, shall be punished by a fine of not more than three thousand dollars or by imprisonment in a house of correction for not more than one year, or both such fine and imprisonment. The term “hazing” as used in this section and in sections eighteen and nineteen, shall mean any conduct or method of initiation into any student organization, whether on public or private property, which willfully or recklessly endangers the physical or mental health of any student or other person. Such conduct shall include whipping, beating, branding, forced calisthenics, exposure to the weather, forced consumption of any food, liquor, beverage, drug or other substance, or any other brutal treatment or forced physical activity which is likely to
adversely affect the physical health or safety of any such student or other person, or which subjects such student or other person to extreme mental stress, including extended deprivation of sleep or rest or extended isolation. Notwithstanding any other provisions of this section to the contrary, consent shall not be available as a defense to any prosecution under this action.
Chapter 269: Section 18: Failure to report hazing:
Whoever knows that another person is the victim of hazing as defined in section seventeen and is at the scene of such crime shall, to the extent that such person can do so without danger or peril to himself or others, report such crime to an appropriate law enforcement official as soon as reasonably practicable. Whoever fails to report such crime shall be punished by a fine of not more than one thousand dollars.
Chapter 269: Section 19. Copy of Secs. 17 to 19: issuance to students and student groups, teams and organizations; report
Each institution of secondary education and each public and private institution of post secondary education shall issue to every student group, student team or student organization which is part of such institution or is recognized by the institution or permitted by the institution to use its name or facilities or is known by the institution to exist as an unaffiliated student group, student team or student organization, a copy of this section and sections seventeen and eighteen; provided, however, that an institution’s compliance with this section’s requirements that an institution issue copies of this section and sections seventeen and eighteen to unaffiliated student groups, teams or organizations shall not constitute evidence of the institution’s recognition or endorsement of said unaffiliated student groups, teams or organizations. Each such group, team or organization shall distribute a copy of this section and sections seventeen and eighteen to each of its members, plebes, pledges or applicants for membership. It shall be the duty of each such group, team or organization, acting through its designated officer, to deliver annually, to the institution an attested acknowledgement stating that such group, team or organization has received a copy of this section and said sections seventeen and eighteen, that each of its members, plebes, pledges, or applicants has received a copy of sections seventeen and eighteen, and that such group, team or organization understands and agrees to comply with the provisions of this section and sections seventeen and eighteen. Each institution of secondary education and each public or privat e institution of post secondary education shall, at least annually, before or at the start of enrollment, deliver to each person who enrolls as a full time student in such institution a copy of this section and sections seventeen and eighteen. Each institution of secondary education and each public or private institution of post secondary education shall file, at least annually, a report with the board of higher education and in the case of secondary institutions, the board of education, certifying that such institution has complied with its responsibility to inform student groups, teams or organizations and to notify each full time student enrolled by it of the provisions of this section and sections seventeen and eighteen and also certifying that said institution has adopted a disciplinary policy with regard to the organizers and participants of hazing, and that such policy has been set forth with appropriate emphasis in the student handbook or similar means of communicating the institution’s policies to its students. The board of higher education and, in the case of secondary institutions, the board of education shall promulgate regulations governing the content and frequency of such reports, and shall forthwith report to the attorney general
any such institution which fails to make such report.
F:\School Climate\Hazing\antihazing statute.doc
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WAREHAM HIGH SCHOOL
CODE OF CONDUCT
FOR INTERSCHOLASTIC STUDENT - ATHLETES
Interscholastic athletic competition should demonstrate high standards of ethics and sportsmanship and promote the development of good character and other important life skills. The highest potential of sports is achieved when participants are committed to pursuing victory with honor according to six core principles: trustworthiness, respect, responsibility, fairness caring, and good citizenship (the “Six Pillars of Character sm”). This Code applies to all student-athletes involved in interscholastic sports in Wareham, MA. I understand that, in order to participate in high school athletics, I must act in accord with the following:
TRUSTWORTHINESS - Trustworthiness – be worthy of trust in all I do.
- Integrity – live up to high ideals of ethics and sportsmanship and always pursue victory with honor; do what’s right even when it’s unpopular or personally costly.
- Honesty – live and compete honorably; don’t lie, cheat, steal or engage in any other dishonest or unsportsmanlike conduct.
- Reliability – fulfill commitments; do what I say I will do; be on time to practices and games.
- Loyalty – be loyal to my school and team; put the team above personal glory.
RESPECT - Respect – treat all people with respect all the time and require the same of other student-athletes.
- Class – live and play with class; be a good sport; be gracious in victory and accept defeat with dignity; give fallen opponents help, compliment extraordinary performance, 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 or racial nature, trash-talking, taunting, boastful celebrations, or other actions that demean individuals or the sport.
- Respect Officials – treat contest officials with respect; don’t complain about or argue with official calls or decisions during or after an athletic event.
RESPONSIBILITY - Importance of Education - be a student first and commit to getting the best education I can. Be honest with myself about the likelihood of getting an athletic scholarship or playing on a professional level and remember that many universities will not recruit student-athletes that do not have a serious commitment to their education, the ability to succeed academically or the character to represent their institution honorably.
- Role-Modeling – Remember, participation in sports is a privilege, not a right and that I am expected to represent my school, coach and teammates with honor, on and off the field. Consistently exhibit good character and conduct myself as a positive role model. Suspension or termination of the participation privilege is within the sole discretion of the school administration.
- Self-Control – exercise self-control; don’t fight or show excessive displays of anger or frustration; have the strength to overcome the temptation to retaliate.
- Healthy Lifestyle – safeguard your health; don’t use any illegal or unhealthy substances including alcohol, tobacco and drugs or engage in any unhealthy techniques to gain, lose or maintain weight.
- Integrity of the Game – protect the integrity of the game; don’t gamble. Play the game according to the rules.
FAIRNESS - Be Fair – live up to high standards of fair play; be open-minded; always be willing to listen and learn.
CARING - Concern for Others - demonstrate concern for others; never intentionally injure any player or engage in reckless behavior that might cause injury to myself or others.
- Teammates – help promote the well-being of teammates by positive counseling and encouragement or by reporting any unhealthy or dangerous conduct to coaches.
CITIZENSHIP - Play by the Rules – maintain a thorough knowledge of and abide by all applicable game and competition rules.
- Spirit of Rules – honor the spirit and the letter of rules; 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. I understand that I’m expected to perform according to this code and I understand that there may be sanctions or penalties if I do not.
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WAREHAM HIGH SCHOOL HOME OF THE VIKINGS
ATHLETIC PARENTAL CONSENT FORM
We the undersigned father and mother or guardian(s) of said student, a minor, do hereby consent to his/her participation in voluntary athletic programs and do forever RELEASE, acquit, discharge and covenant to hold harmless the Town of Wareham, a municipal corporation of the State of Massachusetts, and its successors, departments, officers, employees, servants and agents, of and from any and all actions, causes of actions, claims, demands, damages, costs, loss of services, expenses and compensation on account of, or in any way growing out of, directly or indirectly, all known and unknown personal injuries or property damages we/I may now or hereafter have as the parent(s) or guardian(s) of said minor, and also all claims or right of action for damages said minor has or hereafter may acquire, either before or after he/she has reached his/her maturity resulting or to result from his/her participation in the Wareham Public Schools athletic programs; FURTHERMORE, we/I hereby agree to protect the Town of Wareham and its successors, departments, officers, employees, servants and agents, against any claims for damages, compensation or otherwise on the part of said minor growing out of or resulting from injury to said minor in connection with his/her participation in the Wareham Public Schools voluntary athletic programs, and to INDEMNIFY, reimburse or make good to the Town of Wareham or its successors, departments, officers, employees, servants and agents any loss or damages or costs, including attorney’s fees the Town or its representatives may have to pay if any litigation arises from said minor’s intentional, grossly negligent or reckless acts or omissions while participating in said sports program. We/I also give permission for emergency medical care to be initiated at a hospital should a situation arise where we/I, parent(s) or guardian(s) cannot be contacted. In the event of a medical emergency, if I am not available, I give my permission to WHS coaches and staff to secure proper evaluation/treatment of my son/daughter by any duly licensed physician and/or hospital facility in the event of illness or injury. I also grant permission for the evaluation/treatment of my child by the Athletic Trainer. I also authorize transportation in an ambulance if necessary.I give the medical staff at Wareham School permission to communicate and have access to any medical information regarding my child's injury, illness, past medical history, allergies, or any other pertinent information necessary for my child's care, to / from the team physicians, or any other physician(s) involved in my child's care, the Athletic Trainer, emergency medical technicians (EMT), school nurses, my child's coaches and any member of the school's medical staff in order to facilitate care of my child. I verify that all responses relating to medical information and concussions are true to the best of my knowledge.Furthermore, we/I have read the athletic code of conduct as appears in the student handbook and agree to abide by its rules and regulations. Students will not be permitted to participate in athletics if they are not on the roster before the first game.
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SIGNATURE AND AUTHORIZATION
By clicking SEND on this form, you authorize that you are the legal parent of the student named in this form and that you recognize that this is your legal and binding electronic signature and that any fraud or inaccuracy will void this student's eligibility.
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