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Pre-Participation History & Health Assesment Form

Please complete the form below. Required fields marked with an asterisk *

 

PLEASE NOTE BEFORE PROCEEDING. There are three parts to this online form. One is the completion of this form. The second and third are the printing of, completion of, and scanning of the SCISA Physical Examination Form and the Pre-Participation Physican Evaluation form. These form are under 2022-2023 Doctor Physical tab. For ease of use, parent(s) and student may want to have the student's physician complete the SCISA Physical Examination Form before completing this process online.

If you can not upload the forms with this online document, please email the forms directly to Coach Deter at [email protected] Be sure to indicate your athlete's first and last name in the email memo.

This online form is to be filled out by the parent(s) and student. This process should take no longer than 15 minutes. Once completed the form will not be able to be altered online.

Please note that the SCISA Physical Examination Form must be printed off and completed by the student's physician. Once completed, the Physical Examination Form can be uploaded at the time of completing this form OR can be given to the Cardinal Newman Athletic Trainer. The physician should keep this form with the student’s records.

NEW STUDENTS ATHLETES: The New Student Transfer Form may also be uploaded with the completion of this document. If you can not upload this form you may submit it to the Cardinal Newman Athletic Trainer.

School:  Cardinal Newman School/Bishop of Charleston a Corporation Sole

Sex:*
Answer Required
State*
Answer Required

Attention parent or guardian and athlete:  answers to the following questions are very important!  Please take the time to answer each question to the best of your knowledge.

Do you have allergies?
Answer Required
If yes, please indicate specific allergy:
Answer Required

Concussions

Have you ever had a head injury or concussion?*
Answer Required
Have you had more than one head injury or concussion?*
Answer Required
Have you ever had a blow to the head that caused confusion, porlonged headache, or memory loss?*
Answer Required

Parent's Permission & Acknowledgement of Risk for Son or Daughter to Participate in Athletics

As the parent or legal guardian of the above named student athlete, I give my permission for his/her participation in athletic events and the physical evaluation for that participation. I grant permission for treatment deemed necessary for a condition arising during participation in these events, including medical or surgical treatment that is recommended by a medical doctor. I grant permission to nurses, trainers, coaches, doctors or those under their direction who are part of the athletic injury prevention or treatment, to have access to necessary medical information. I know that the risk of injury to my child/ward comes with participation in sports and during travel to and from play and practice. My signature indicates that to the best of my knowledge, my answers to the above

Pre-Participation Physical Evaluation Medical History Questionnaire

Attention parent or guardian and athlete:  answers to the following questions are very important!  Please take the time to answer each question to the best of your knowledge.  Explain "Yes" answeres below.

1. Has the doctor ever denied or restricted you participation in sports for any reason?*
Answer Required

Heart Health Questions About You

5. Have you ever passed out or nearly passed out during or after exercise?:*
Answer Required
6. Have you ever had pain, discomfort, tightness, or pressure in your chest during exercise?*
Answer Required
7. Does your heart ever race or skip a beat (irregular beats) during exercise?:*
Answer Required
8. Has your doctor ever told you that you have any heart problems?*
Answer Required
If so, check all that apply:
Answer Required
9. Has a doctor ever ordered a test for your heart?:*
Answer Required
10. Do you get lightheaded or feel more short of breath more than expected during exercise?:*
Answer Required
11. Have you ever had an unexplained seizure?:*
Answer Required
12. Do you get more tired or short of breath more quickly than you friends during exercise?:*
Answer Required

Health Questions About Your Family

13. Has any family member or relative died of heart problems or had an unexpected sudden death before age 35?:*
(including drowning, unexplained car accident, sudden death syndrome)
Answer Required
14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, shot QT Syndrome, Brugada syndrome, or catecholaminergic, polymorphic ventricular tachycardia?:*
Answer Required
15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator before age 35?*
Answer Required
16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?:*
Answer Required

Bone and Joint Questions

17. Have you ever had a stress fracture or an injury to a bone, muscle, ligament, joint or tendon that caused you to miss a game or practice?:*
Answer Required
18. Have you ever had any broken or fractured bones or dislocated joints or any bone, muscle, ligament or joint injury that bothers you during your participation in sports?:*
Answer Required
19. Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace, cast, or crutches?:*
Answer Required
20. Have you ever had a stress fracture?:*
Answer Required
21. Do you regularly use a brace, orthotics, or other assistive device?:*
Answer Required
22. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down Syndrome or dwarfism):*
Answer Required
23. Do you have a bone, muscle, or joint injury that bothers you?*
Answer Required
24. Do any of your joints become painful, swollen, feel warm, or look red?:*
Answer Required
25. Do you have any history of juvenile arthritis or connective tissue disease?:*
Answer Required

Medical Questions

26. Do you cough, wheeze, or have difficulty breathing during or after exercise?:*
Answer Required
27. Have you ever used an inhaler or taken asthma medicine?:*
Answer Required
28. Is there anyone in your family who has asthma?:*
Answer Required
29. Were you born without or are you missing a kidney, eye, a testicle (males), your spleen, or any other organ?:*
Answer Required
30. Do you have groin pain or a painful bulge or hernia inthe groin area?:*
Answer Required
31. Have you had infectious mononucleosis (mono) in the last month?:*
Answer Required
32. Do you have any rashes, pressure sores, or other skin problems?:*
Answer Required
33. Do you have any recurring skin rashes or rashes that come and go, including herpes or methicillin-resistant Staphylococcusaureus (MRSA)?:*
Answer Required
34. Do you have a history of seizure disorder?:*
Answer Required
35. Have you ever had a concussion or head injury that caused confusion, a prolonged headache, or memory problem?:*
Answer Required
36. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling?:*
Answer Required
37. Have you ever been unable to move your arms or legs after being hit or falling?:*
Answer Required
38. Have you ever become ill while exercising in the heat?:*
Answer Required
39. Do you get frequent muscle cramps when exercising?:*
Answer Required
40. Do you or someone in your family have sickle cell trait or disease?:*
Answer Required
41. Have you had any problems with your eyes or vision?:*
Answer Required
42. Have you had any eye injuries?:*
Answer Required
43. Do you wear glasses or contact lenses?:*
Answer Required
44. Do you were protective eyewear, such as goggles or a face shield?:*
Answer Required
45. Do you worry about your weight?:*
Answer Required
46. Are you trying or has anyone recommended that you gain or lose weight?:*
Answer Required
47. Are you on a special Diet or do you avoid certain types of foods?:*
Answer Required
48. Have you ever had an eating disorder?:*
Answer Required
49. Do you have any concerns that you would like to discuss with a doctor?:*
Answer Required

Females Only

50. Have you ever had a menstrual period?
Answer Required

By typing my name below, I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

PHYSICAL EVALUATION FORM

Upload your completed Physical Examination Form:*
Answer Required
or drag it here.

AGREEMENT FOR PARTICIPATION

 

1. Statement of Philosophy
 
The primary purpose of school is education. The participation in athletics is a privilege for those students who are eligible according to rules and policies of the SCISA.
 
2. Summary of The Code of Conduct:
 
All fans, spectators, coaches, and student-athletes are encouraged to enthusiastically support his/her school and team. We all must realize that the athletic arena is an extension of the classroom. Valuable lessons other than winning and losing are taught. The safety and well-being of students, coaches, and officials is of utmost importance to us all. Athletic events shall be conducted in accordance with the policies, rules, and regulations of the South Carolina Independent School Association. Participants, coaches, and spectators shall at all times conduct themselves in a reasonable and sportsmanlike manner.
A participant, coach or fan will be in violation of the Code of Conduct upon any one or more of the following actions:
- By making any degrading remark about any fan, official, coach, or athlete during or after a game, either on or off the field/floor of play.
- By arguing with an official or going through motions indicating dislike or disdain for a decision.
- By using any foul, abusive, or profane language at any time.
- By entering the playing area or field to protest, question, or object to a call or play.
- By hitting, shoving or striking any official, coach, athlete or fan at any time (or attempting to do so).
- By being ejected/removed from any contest.
- By detaining an official following the contest to request a ruling or explanation. By following/chasing after the official after a game to express your displeasure or opinion with a call or result of a play or game.
- By the use or display of alcohol, tobacco or an unauthorized drug.
Violations of the Code of Conduct could result in a school, player or fan being fined, suspended or placed on probation. The school shall be notified of the action taken by SCISA and will be responsible for the enforcement of the action.
 
3. Warning of Inherent Risk/Dangers of Athletic Participation
 
Participation in athletics includes the risk of injury which may range in severity from minor to disabling to even death. Although serious injures are not common in supervised programs, it is impossible to eliminate the risk. Participants can and do have a responsibility to help reduce the chance of injury. Participants must obey all safety rules, report all physical problems, follow guidelines for safe play and inspect his/her own equipment and report any problems.

We understand that the Participation in athletics and by attending public events (such as sporting events) includes possible exposure to an illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19.
 
4. Recruiting:
 
A student must not have transferred as a result of recruiting or undue influence. Refer to SCISA Blue Book for clarification of recruiting.
 
5. Guardianship:
 
A student must reside with his/her parent(s) to be eligible for athletic participation. Refer to the SCISA Blue Book for a clarification of a legally appointed guardian.
 
6. Summary of Student Eligibility Rules
 
Eight Semester Rule: A student has Eight (8) Consecutive Semesters of eligibility from the time he/she first enters the ninth (9th) grade.

Academic Requirements: A student in grades 9-12 must take and pass at least four (4), one unit CORE courses or any five (5), one unit courses each grading period/semester. Students below the 9th grade must pass four (4) subjects each grading period/semester. A senior who has met or is meeting all requirements for graduation must pass four (4), one credit courses each marking period/semester. Note: a student must have earned at least four (4) core units or any five (5) units of credit to be declared eligible at the start of a school year. Also, credits or courses taken by the “Home School” method during the school year are not eligible for athletic eligibility determination.

Any student who did not receive credit for at least 50% (one-half) of all courses taken the previous school year cannot be declared eligible for athletic participation until the successful completion of the first semester.

A student who is academically ineligible to participate is also prohibited from practicing with the team until the time he/she is academically eligible to participate.

Grade Level Requirements/Restrictions:
Varsity Teams: Eligible students in grades 8-12 may participate on varsity teams in baseball, basketball, soccer, football, lacrosse and softball. Eligible students in grades 6-12 may participate on all other varsity teams. Note: To address player safety, coaches and parents must carefully evaluate the skill level and physical competitiveness of students below the 9th grade before permitting participation on any varsity team. Specialty sport programs may have additional restrictions.

Junior Varsity Teams: Sport specific grade restrictions exists for junior varsity teams. Eligible students in grades 5-10 may participate on junior varsity teams in track, cross country, swimming, volleyball, golf, and tennis. Eligible students in grades 6-10 may participate on junior varsity teams in basketball, baseball, softball, soccer, and wrestling.

Junior Varsity Football: Eligible students in grades 6-9 may participate in junior varsity football. (*Agreement Exception)
Note: To address player safety, coaches and parents must carefully evaluate the skill level and physical competitiveness of students below the 9th grade before permitting participation on any junior varsity team.

B-Teams: Eligible students in the 5th-8th grades may participate on B-Teams in all sports except football.

B-Team Football: Eligible students in the 5th-7th grades may participate on B-Team football. Note: To address player safety, coaches and parents must carefully evaluate the skill level and physical competitiveness of students below the 6th grade before permitting participation on any B-Team.

Age Requirements/Restrictions: Note: There are no exceptions to the age standards.
• A student is INELIGIBLE to participate in athletics if his/her 19th birthday is before July 1, 2020.
• Junior Varsity: In order to participate in junior varsity athletics a student must not have reached his/her sixteenth (16th) birthday before July 1, 2020.
• B-Team: In order to participate in B-Team athletics a student must not have reached his/her fifteenth (15th) birthday before July 1, 2020. Exception: B-Team Football: In order to participate in B-Team football, a student must not have reached his/her fourteenth (14th) birthday before July 1, 2020.

Transfer Rules:
A student who transfers after having: A. attended one class or B. filed the Agreement for Participation during the defined sports season or practices with team on or after the first official practice date must wait sixty (60) days to become eligible. This may be waived for a bono fide change in residence. The Sixty Days may be waived following league/Committee review if all of the following conditions are met to the satisfaction of the Committee at it’s sole and absolute discretion for a non-member to member transfer: A. The student has completed a Transfer Form; B. The parents provide a statement detailing the reason for the transfer; C. The student enrolls in the SCISA member school on or before: 1. September 15th for fall sports; 2. January 8th for winter sports. D. If approved, a transfer must participate in ten (10) days of practice before he/she is allowed to participate in a game. Second semester transfers are subjected to the Sixty Day Rule (transfers after January 8th/end of 1st semester). The following additional policies are also in effect:
• A transfer must have attended classes for thirty days prior to the start of the play-offs to be eligible to participate in the play-offs.
• An academically eligible transfer student (school year transfer as defined above) must have been eligible to represent his/her former school under any school, student, or athletic policy that was in place when the student transferred or the student must wait for ninety (90) calendar days to become eligible. The Committee reserves the right to extend this period if conditions so warrant.
• A student who transfers before the start of the school year (has not attended one class and has not practiced with the team on or after the first official practice date) and has met all eligibility standards is eligible for athletic participation.

Medical Insurance Coverage Statement
It is important for a parent to understand his/her school’s medical insurance coverage policy. SCISA requires that each school participate in the associational catastrophic plan which provides coverage in the event of a catastrophic injury.

New Student / Transfer Student
Any new student to your school or transfer student who plays a varsity sport must complete a New Student/Transfer Student Form (Parent Form and School form).

All-Star Participation: If selected, you also give permission for your son or daughter to participate in SCISA All-Star Games. You also agree not to hold the South Carolina Independent School Association, the host school or any of its agents, members, employees, or affiliate organizations responsible in the event of an accident or injury. You further au-thorize any and all emergency medical treatment for the player named and will be responsible for any and all such cost.

Participant and Parent/Legal Guardian Permission

The above named student has my permission to participate in athletics. We have read and understand the philosophy of the SCISA, the Code of Conduct, and the Summary of Eligibility Rules. We un-derstand that there are inherent risks in all athletics and that injuries do occur. The South Carolina Independent School Association may examine school records of the student whose name appears above in order to verify eligibility. I under-stand that this form is considered to be a binding contract. The student whose name appears above may only participate in athletics for the school named below. Transfer to another school after this form has been filed will subject the student to the Sixty Day Rule. I also agree not to hold the South Carolina Independent School association or any of its agents, members, employees or affiliate Organizations responsible in the event of an accident or injury. I further authorize any and all emergency medical treatment for the student named and will be responsible for any and all such cost while participating in SCISA.

Name of School:  Cardinal Newman School/Bishop of Charleston a Corporation Sole

Warning of Inherent Risk
Assumption of Risk/ Waiver of Liability/ Indemnification Agreement
Minor Waiver/Release

RELEASE OF LIABILITY FOR MINOR PARTICIPANTS READ BEFORE SIGNING
 
Participation in athletics includes the risk of injury which may range in severity from minor to disabling to even death. Although serious injures are not common in supervised programs, it is impossi-ble to eliminate the risk. Participants can and do have a responsibility to help reduce the chance of injury. Participants must obey all safety rules, report all physical problems, follow guidelines for safe play and inspect his/her own equipment and report any problems.

Waiver/Release from Communicable Diseases including COVID-19

In consideration of being allowed to participate in my school's athletic program in SCISA and related events and activities the undersigned acknowledges, appreciates, and agrees that: Participation includes possible exposure to an illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exits; and, I knowingly and freely assume all such risks, both known and unknown, even if arising from the negligence of the releases or others, and assume full responsibility for my participation.
School Name: Cardinal Newman School/Bishop of Charleston a Corporation Sole
 
IN CONSIDERATION OF the above mentioned student, my child/ward, being allowed to participate in any way in the related events and activities of the SCISA Athletic Association and this school’s athletic program, the undersigned acknowledges, appreciates, and agrees that:

1. The risk of injury to my child/ward from the activities involved in athletic programs exist, including the potential for permanent disability and death, and while particular rules, equipment, and personal discipline may reduce this risk, the risk of serious injury does exist; and,

2. Participation includes possible exposure to an illness form infectious diseases including but not limited to MRSA, influenza, and COVID-19. While particular rules and personal discipline may reduce this risk, the risk of serious illness and death does exist.

3. I FOR MYSELF, SPOUSE, AND CHILD/WARD, I KNOWINGLY AND FREELY ASSUME ALL SUCH RISKS, both known and unknown, and assume full responsibility for my child/ward’s participation; and,

4. I willingly agree to comply with the program’s stated and customary terms and conditions for participation. If I observe any unusual significant concern in my child/ward’s readiness for participation and/or in the program itself, I will remove my child/ward from the participation and bring such to the attention of the nearest official
immediately; and,

5. I for myself, my spouse, my child/ward, and on behalf of my/our heirs, assigns, personal representatives and next of kin, HEREBY RELEASE AND HOLD HARMLESS The South Carolina Independent School Association,
the aboved mentioned school and its directors, officers, officials, agents, employees, volunteers, other participants, sponsoring agencies, sponsors, advertisers, and if applicable, owners and lessors of premises used to conduct the Event, WITH RESPECT TO ANY AND ALL INJURY, DISABILITY, DEATH, or loss or damage
to person or property incident to my child/ward’s involvement or participation in these programs.

6. I grant permission to athletics trainers, first responders, nurses, and coaches as well as physicians or those under their direction who are a part of athletic prevention and treatment, to have access to necessary medical information.

7. I understand that the physical evaluation for participation is simply a screening evaluation and not a substitute for regular health care.
 
I HAVE READ THIS RELEASE OF LIABILITY AND ASSUMPTION OF RISK AGREEMENT, FULLY UNDERSTAND ITS TERMS,
Student Participant Understanding of Risk

Warning of Inherent Risk

This school strives to protect each student from possible injury while engaging in school activities. Participants and their parents should recognize that conditioning, nutrition, proper techniques, safety procedures, and well-fitting equipment are important aspects of our school’s overall student-safety program. Each participant is expected to follow the directions/standards of the coach and must understand that failure to follow such directions or adhere to standards may place the participant at risk.

We accept and understand that participation in athletics involves certain inherent risks, dangers and hazards that may cause serious personal injury, including death, severe paralysis or brain injury necessitating long term care and significantly impairing enjoyment of life or life activities. We accept and understand that the above-described injuries and other injuries, including but not limited to: concussions; serious neck and spinal injuries potentially resulting in complete or partial paralysis; brain damage; blindness; serious injury to all internal organs; serious injury to all bones, joints, ligaments, muscles and tendons; contusions; dislocations; sprains; strains; and fractures, may occur as a result of participating in this sport.

We accept and understand that participation in athletics and by attending public events as spectators includes possible exposure to an illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19.

Participation in athletics includes the risk of injury which may range in severity from minor to disabling to even death. Although serious injures are not common in supervised programs, it is impossible to eliminate the risk. Participants can and do have a responsibility to help reduce the chance of injury. Participants must obey all safety rules, report all physical problems, follow guidelines for safe play and inspect his/her own equipment and report any problems.
 
We understand that the inherent risks of participation in athletics cannot be eliminated. We have reviewed all of these risks and we understand and appreciate them and still desire to participate in the activity

We understand that Participation includes possible  exposure to an illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19.

We understand that attending public events (including sporting events) includes possible exposure to an illness from infectious diseases including but not limited to MRSA, influenza, and COVID-19.

has no medical or physical conditions which could interfere with or compromise his/her safety in participating in this activity.

In the event it becomes necessary for school district staff to obtain emergency medical care for the above-named student, we understand that neither the staff member nor the school district assumes financial liability for the expenses incurred because of the accident, injury, illness and/or unforeseen circumstances.

I certify that my household has sufficient medical insurance to facilitate any necessary medical care or resultant care for any injury that may be sustained by the above-named student.

I authorize qualified emergency medical professionals to examine, and in the event of an injury or serious illness, to administer emergency medical care to the above-named student.
Having read and initialed the statements above, I acknowledge that I have read and fully understand the RISKS associated with participating in this voluntary school athletic program. By signing below I certify that I have read the above, understand its content and wish to participate.
 
I understand the seriousness of the risks involved in participating in an athletic program, my personal responsibilities for adhering to rules and regulation, and accept them as a participant.

Having read and initialed the statements above, I acknowledge that I have read and fully understand the RISKS associated with participating in this voluntary school athletic program. By signing below I certify that I have read the above, understand its content and give my permission for my student to participate.

Student/Parent Concussion Awareness Form
Information for Student-Athletes and Parents / Legal Guardians
 
Concussions at all levels of sports have received a great deal of attention and a state law has been passed to address this issue. Adolescent athletes are particularly vulnerable to the effects of concussion. Once considered little more than a minor “ding” to the head, it is now understood that a concussion has the potential to result in death, or changes in brain function (either short-term or long-term). A concussion is a brain injury that results in a temporary disruption of normal brain function. A concussion occurs when the brain is violently rocked back and forth or twisted inside the skull as a result of a blow to the head or body. Continued participation in any sport following a concussion can lead to worsening concussion symptoms, as well as increased risk for further injury to the brain, and even death. Player and parental education in this area is crucial – that is the reason for this document.

What is a concussion? A concussion is an injury to the brain caused by a direct or indirect blow to the head. It results in your brain not working as it should. It may or may not cause you to black out or pass out. It can happen to you from a fall, a hit to the head, or a hit to the body that causes your head and your brain to move quickly back and forth.

How do I know if I have a concussion? There are many signs and symptoms that you may have following a concus-sion. A concussion can affect your thinking, the way your body feels, your mood, or your sleep.

Here is what to look for:

Thinking/Remembering:
Difficulty thinking clearly
Taking longer to figure things out
Difficulty concentrating
Difficulty remembering new information

Physical:
Headache
Fuzzy or blurry vision
Feeling sick to your stomach/queasy
Vomiting/throwing up
Dizziness
Balance problems
Sensitivity to noise or light

Emotional/Mood:
Irritability-things bother you more easily
Sadness
Being more moody
Feeling nervous or worried
Crying more

Sleep:
Sleeping more than usual
Sleeping less than usual
Trouble falling asleep
Feeling tired

Table is adapted from the Centers for Disease Control and Prevention (https://www.cdc.gov/concussion/)

What should I do if I think a student-athlete has sustained a concussion? If you suspect a student-athlete is experi-encing any of the signs and symptoms listed above, you immediately remove them from participation, let their parents know, and/or refer them to the appropriate medical personnel.

What are the warning signs that a more significant head injury may have occurred? If they have a headache that gets worse over time, experience loss of coordination or abnormal body movements, have repeated nausea, vomiting, slurred speech, or you witness what you believe to be a severe head impact, you should refer them to appropriate medical personnel immediately.

What are some of the long-term or cumulative issues that may result from a concussion? Individuals may have trouble in some of their classes at school or even with activities at home. Down the road, especially if their injury is not managed properly, or if they return to play too early, they may experience issues such as being depressed, not feeling well, or have trouble remembering things for a long time. Once an individual has a con-cussion, they are also more likely to sustain another concussion.

How do I know when it’s ok for a student-athlete to return to participation after a suspected concussion? Any student-athlete experiencing signs and symptoms consistent with a concussion should be immediately removed from play or practice and referred to appropriate medical personnel. They should not be returned to play or practice on the same day. To return to play or practice, they will need written clearance from a medical professional trained in concussion management.
 
Student-Athlete & Parent/Legal Custodian Concussion Statement
If there is anything on this sheet that you do not understand, please ask a coach/staff member to explain or read it to you.
Yes, we have read the Student-Athlete & Parent/Legal Custonidan Concussion Information Sheet:*
Answer Required
By initialing at the bottom of this section, you are indicating that you have read and and understand each statement.
 
* A concussion is a brain injury, which should be reported to my parents, my
coach(es), or a medical professional if one is available.

* A concussion can affect the ability to perform everyday activities such as the ability
to think, balance, and classroom performance.

* A concussion cannot be “seen.” Some symptoms might be present right away. Other
symptoms can show up hours or days after an injury.

* I will tell my parents, my coach, and/or a medical professional about my injuries and
illnesses.

* If I think a teammate has a concussion, I should tell my coach(es), parents, or
medical professional about the concussion.

* I will not return to play in a game or practice if a hit to my head or body causes any
concussion-related symptoms.

* Based on the latest data, most concussions take days or weeks to get better. A
concussion may not go away right away. I realize that resolution from this injury is a
process and may require more than one medical evaluation.

* I realize that ER/Urgent Care physicians will not provide clearance if seen right away
after the injury.

* After a concussion, the brain needs time to heal. I understand that I am/my child is
much more likely to have another concussion or more serious brain injury if return to
play or practice occurs before concussion symptoms go away.

* Sometimes, repeat concussions can cause serious and long-lasting problems.

* I have read the concussion symptoms on the Concussion Information Sheet.

SCISA CONCUSSION POLICY:
In accordance with South Carolina/Georgia law and national playing rules published by the National Federation of State High School Associations, any athlete who exhibits signs, symptoms, or behaviors consistent with a concussion shall be immediately removed from the practice or contest and shall not return to play until an appropriate health care professional has determined that no concussion has occurred. (NOTE: An appropriate health care professional may include licensed physician (MD/DO) or another licensed individual under the supervision of a licensed physician, such as a nurse practitioner, physician assistant, or certified athletic trainer who has received training in concussion evaluation and management).

1) No athlete is allowed to return to a game or a practice on the same day that a concussion (a) has been diagnosed, OR (b) cannot be ruled out.

2) Any athlete diagnosed with a concussion shall be cleared medically by an appropriate health care professional prior to resuming participation in any future practice or contest. The formulation of a gradual return to play protocol shall be a part of the medical clearance.

3) It is mandatory that every coach in each SCISA sport participate in a free, online course on concussion management prepared by the NFHS and available at www.nfhslearn.com every year

4) Each school will be responsible for monitoring the participation of its coaches in the concussion management course, and shall keep a record of those who participate.

Cardinal Newman School

Athletic Department Student Transportation Waiver

As the parent/guardian of the above mentioned student, a student in the above mentioned grade at Cardinal Newman School and participant in a sport under the Athletic Department,

I give my permission for her/him to use transportation provided by the athletic department through Cardinal Newman School, in order to travel to and from practices and games/matches.

I understand that Cardinal Newman School cannot be responsible for assigning or monitoring with whom my child rides, and I hereby waive and fully and forever discharge the Diocese of
Charleston, Cardinal Newman School, and all of its administrators, teachers and staff, supervisors, agents, and coaches, from liabilities, claims, demands, suites and causes of action of every kind in any way relating to or arising out of her/his participation in the above activity.

If applicable, upload the New Student/Transfer Student Form Admission Information for Athletic Eligibility:
Answer Required
or drag it here.
Is the student a football player?*
(If yes, please read and complete below:
Answer Required
Football Warning: Helmet, Equipment, and Technique
 
According to the National Federation (High School Rules) and NCAA Sports Medicine Hand- book, “all players shall wear helmets that carry a warning label regarding the risk of injury”. This warning label is secured to the exterior of the helmet shell and must be visible and legible at all times. The warning label states:

WARNING

Do not strike an opponent with any part of this helmet or facemask. This is a violation of football rules and may cause you to suffer severe brain or neck injury, including paralysis or death. Severe brain or neck injury may also occur accidentally while playing football.

NO HELMET CAN PREVENT ALL SUCH INJURIES.

YOU USE THIS HELMET AT YOUR OWN RISK.

The National Federation (High School Rules) has identified specific guidelines against a player using their head as a weapon and as the initial point of contact for blocking and tackling.

The equipment issued to you should not be modified, by you, in any way. Any potential modifications to your protective equipment must be brought to the attention of the Athletic Training staff and/or Football coaching staff in advance, this includes adapting or exchanging helmets, shoulder pads, and adding or deleting neck rolls.

PLAY HEADS UP FOOTBALL!
DON'T BLOCK OR TACKLE WITH THE TOP OF YOUR HELMET.
REMEMBER.....
SEE WHAT YOU HIT!
PROTECT YOUR SPINE AND NECK!

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