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Athletic Packet- High School- 2018-2019

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  • STUDENT & EMERGENCY MEDICAL PROFILE INFORMATION

    Your son/daughter has requested the privilege of taking part in our athletic program. Before he/she may take part, it is necessary for us to have your consent by completing the forms included in this packet.

  • STUDENT ADDRESS

  • Parent/Guardian/Emergency Contact Information

  • Physician/Medical Information

  • Write 'none' if you do not have any allergies.
  • List any operations or illnesses your child has had since his last physical.
  • PARENTAL CONSENT

  • NJSIAA Concussion Policy Acknowledgement Form

    In order to help protect the student-athletes of New Jersey, the State of New Jersey and the NJSIAA have mandated that the Wayne Public Schools District, and all student-athletes, parents/guardians and coaches follow the Concussion Management Policy.

    For up-to-date information on concussions, you can go to:
    Concussions In Youth Sports or NFHS Learn.
  • NJSIAA Steroid Testing Policy Consent To Random Testing

    In Executive Order 72, issued December 20, 2005, Governor Richard Codey directed the New Jersey Department of Education to work in conjunction with the New Jersey State Interscholastic Athletic Association (NJSIAA) to develop and implement a program of random testing for steroids, of teams and individuals qualifying for championship games.

    Beginning in the Fall, 2006 sports season, any student-athlete who possesses, distributes, ingests or otherwise uses any of the banned substances on the attached page, without written prescription by a fully-licensed physician, as recognized by the American Medical Association, to treat a medical condition, violates the NJSIAA’s sportsmanship rule, and is subject to NJSIAA penalties, including ineligibility from competition. The NJSIAA will test certain randomly selected individuals and teams that qualify for a state championship tournament or state championship competition for banned substances. The results of all tests shall be considered confidential and shall only be disclosed to the student, his or her parents, and his or her school. No student may participate in NJSIAA competition unless the student and the student’s parent/guardian consent to random testing.

    By signing below, we consent to random testing in accordance with the NJSIAA steroid testing policy. We understand that if the student or the student’s team qualifies for a state championship tournament or state championship competition, the student may be subject to testing for banned substances.
  • Sudden Cardiac Death in Young Athletes

    All student-athletes and their parents need to read and become familiar with the Sudden Cardiac Death in Young Athletes brochure.
  • Opioid Use and Misuse Fact Sheet

    In accordance with N.J.S.A. 18A:40-41.10, public school districts, approved private schools for students with disabilities, and nonpublic schools participating in an interscholastic sports program must distribute the Opioid Use and Misuse Educational Fact Sheet to all student-athletes and cheerleaders. In addition, schools and districts must obtain a signed acknowledgement of receipt of the fact sheet from each student-athlete and cheerleader, and for students under age 18, the parent or guardian must also sign.

    In accordance with the law, the fact sheet must be distributed and a sign-off sheet completed and collected for each student-athlete or cheerleader prior to the first official practice session of the spring 2018 athletic season (March 2, as designated by the New Jersey State Interscholastic Athletic Association), and annually thereafter prior to the student’s first official practice of the school year.
  • HEALTH HISTORY UPDATE

    The parent or guardian of each student-athlete must complete and sign an updated health history questionnaire if the pre-participation physical examination was conducted 90 or more days prior to the first practice session of the athletic season. The health history update questionnaire addresses the specific questions recommended by the American Heart Association.

    Since the last pre-participation physical examination, has your son/daughter:
  • PREPARTICIPATION PHYSICAL EVALUATION

    HISTORY FORM
  • Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking.
  • Check all that apply
  • Select all that apply
  • Select all that apply
  • Declaration

    I declare that my signature below signifies my understanding and concurrence with the information completed in the Athletic Packet, which includes:
    - Student/Emergency Contact Information
    - Concussion Policy
    - Steroid Consent to Random Testing
    - Sudden Cardiac Death in Young Athletes
    - Educational Fact Sheet on the Use and Misuse of Opioid Drugs

  • Sports Participation Packet
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