2018-19 cheer tryout parent meeting handout€¦ · be determined depending on the natural break....

2018-19 Cheer Tryout Parent Meeting Handout Application Process

• Complete application online by Friday, March 2nd. https://drive.google.com/open?id=1DEpoQxZpPeCZcbifrqfDrV50LcpD5Jto8zx2Mh7tzDA

• Send 1 teachers the following recommendation link : https://drive.google.com/open?id=1ht7t7suyS7g5Kn5i8PulV0aRIpWVvcOd7d-lRBlbIjQ

• Send 2 previous coach (from the last 2 years) the following recommendation link:

https://drive.google.com/open?id=14XeBqqgV8NVM19whQg-YI36TfwxGy-zof5krI18qLAk

• Hand in completely filled out physical. Parent portion and doctor portion. o Physicals can be found here https://cvhsgrizzlies.net/ Go to More, Forms, then Physical Form o Rising 9th Graders submit physical forms at CMS to Erin Abramson room #506 o 9th-11th graders submit forms at CHS to Susan Harmelin’s Office: G4

• Forms:

Tryout Structure Competition: Try-Outs March 19th-23rd

• Each day of competition tryouts we will be focusing on three skills: o Tumbling- Running tumbling, standing tumbling, and jumps connected to a tumbling skill. o Stunting- This includes the technique of flyers, bases, and backspots. o Jumps: Each cheerleader will perform three connected jumps. o Dance: The cheerleaders will perform a dance for tryouts. The video will be posted on 3/2/18

online. The link to the dance will be on https://cvhsgrizzlies.net/ Go to Fall Sports: Girls Competitive Cheer, then Varsity. The athletes are expected to come to tryouts with the tryout dance material already learned.

o Monday, March 19th the cheerleaders will participate in a mile run. Please bring running shoes and cheer shoes this day.

o The tryout information above is subject to change at the discretion of the head coach.

• March 19th, 20th, 21st and 22th: There will be 2 sessions o 4:00-5:30 and 5:30-7:00 o There will be alternate positions on JV and/or Varsity competition. The number of alternates will

be determined depending on the natural break. • Friday, March 23rd :

o Tryouts start at 4:00. Please wear all black. • Tuesday, March 27th :

o Skills Check o 4:00-5:30 and 5:30-7:00

• You may only attend ONE session each day o Second session is reserved for those who play spring sports only and any students who has prior

academic commitments, not HOMEWORK. o We MUST know in advance if you are attending the 2nd session.

For all squads: Friday, March 30th try-out results will posted after 4:00. We will let the cheerleaders know where the results will be posted during the try-out process.

Spirit: (FB/BB) Try-Outs March 26st, 28th, 29th ** Tuesday COMPETITION girls only!**

• Each day of the clinic the girls will be practicing a cheer, chant, and dance that they will be trying out with on the 29th.

• Monday: the girls will learn the cheer, chant, and the dance on this day. • Wednesday: the girls will practice the material from Monday and they will be stunting on this day. • Stunting: Each girl will be placed with a stunt group and will be alternating positions with other

cheerleaders to give the coaches an idea of what positions each cheerleader is able to do. This DOES NOT affect their score on the 29th. We are looking for basic stunts such as a half, a cupie, and a liberty.

• Monday, Wednesday, and Thursday March 26th, 28th, and 29th: There will be 2 sessions. o 4:00-5:30 and 5:30-7:00 o You may only attend ONE session each day o 2nd Session is reserved for those who play spring sports ONLY and any students who has prior

academic commitments, not HOMEWORK ! We must know in advance if you are attending the 2nd session

• Thursday, March 29th o Try-outs start at 4:00. Wear all black.

For all squads: Friday, March 30th try-out results will posted after 4:00. We will let the cheerleaders know where the results will be posted during the try-out process. Fitting

• Monday, April 9th in the cafeteria o Fitting @ 4:00

! CHEERLEADERS ONLY!!! First Parent Meeting

• Monday, April 9th in the cafeteria o Football Meeting @ 6:00 o Competition Meeting @ 6:30

! First payment for both squads is DUE

Tentative On/Off Week Schedule • Week of May 28- OFF (except varsity competition WILL have practice 6/3/18 to prepare for camp) • Week of June 4- ON • Week of June 11-ON • Week of June 18- ON • Week of June 25 OFF • Week of July 2 OFF (GHSA DEAD WEEK) • Week of July 9 ON • After July 9th we will be having practices every week.

Important Dates

• Pageant: May 12th **Tentatively** • Varsity Competition Camp: June 4th & 5th at West GA. Choreography TBD, in an ON WEEK • JV Competition Choreography: June 18th, 19th, and 20th times TBD • Varsity Football Camp: July 9-11th • JV Football Camp: TBA @ TAG

Estimated Costs

• Football ! Mandatory (unless freshman or senior): $255 ! Mandatory Freshman OR new cheerleader: $395 ! Mandatory Senior: $330 ! Varsity Camp: $300—subject to change pending fundraising (July 9-11th) ! JV/Freshman Camp: $100 (Date TBA) ! Optional: $172

• Basketball o Mandatory –

! Varsity: $275 ! JV: $240 ! Booster fee ! Banquet fee ! Basketball cheer shirt

o Many of the optional items will overlap with football o There will be additional costs based on the items you already own

• Competition o Mandatory

! Never cheered - $402 ! Cheered previously - $262

o Camp – Amount varies depending on squad made ! Includes camps, choreography, and music.

Creekview Cheer Constitution

Philosophy: We are a united Cheer family here at Creekview. We support all sports and extracurricular programs with the utmost integrity. We are dedicated to lifting the spirit of Creekview by committing ourselves to building a program that supports and encourages athletes to be well-rounded, responsible, and positive in all aspects of their life. We are dedicated to setting the best example possible for all present and future Grizzlies.

Purpose: The purpose of this sport shall be to promote and uphold school spirit, to develop a sense of good sportsmanship among students, to build a better relationship between schools during athletic events, and to promote the safety and integrity of cheerleading.

Uniforms:

A. Uniforms are the property of Creekview High School. Your coach must approve any alterations or adjustments to the uniforms. If you alter a uniform without permission, you may be required to pay for the replacement of the uniform.

B. Uniforms are to be cleaned after each game. Do not iron or dry clean the uniforms. Follow laundry directions on the uniform tag and do not remove the tags from the uniform.

C. Uniforms and equipment will be signed out by the cheerleaders and should be returned one week after the last game of the season. Uniforms must be cleaned and on a hanger. Failure to turn these items in promptly and in good condition will result in an office debt for the price to replace the uniform.

D. All cheerleaders are required to wear proper under garments that have been approved by the coach.

E. Uniform attire includes warm up pants, white ankle socks, white cheer shoes, crop-top and bloomers, sports bra, hair bow, uniform shell and skirt, and pom-poms. All cheerleaders are required to have all items on game day.

Attendance: Games or Competition/Practice:

A. Cheerleaders must attend all practices, games (including preseason and play-off games), meetings, pep-rallies, team building events, and fundraisers during the season.

B. You are expected to arrive 15 minutes before the time you are scheduled to be there. (15 Minute Rule) If you are on time you are late. This includes all cheer events: practice, games, or competition. Once you arrive, you are to help your teammates roll out mats and start stretching.

Practice/Games/ Competition:

Attire:

A. All cheerleaders are expected to arrive in their CLEAN uniform and prepared to cheer at all games. This includes your hair up and bangs pinned back. On game days, wear the appropriate shirt, track suit pants, shoes, and skirt to school and have your cheer bag packed with pom poms, jackets, socks, long-sleeve crops, bloomers, bows, hair ties, braces, and all other necessary cheer accessories. The coach will indicate appropriate game day attire for school.

B. All cheerleaders must wear the assigned practice clothes at all practices and events. At practice, hair must be pulled away from the face with an elastic band and long bangs must be pinned back.

C. Fingernails must be kept at an appropriate length: if they can be seen from the palm side, they must be cut. Only clear nail polish will be allowed at games..

D. No jewelry of any type will be allowed including: earrings, rings, bracelets, watches, belly rings, necklaces, nose rings, tongue rings, etc. Medical alert tags may be taped to the body. Tattoos must be appropriately covered at all times including practices. No Glitter whatsoever in accordance with GHSA rules.

Games:

A. Cheerleaders must attend all games. All cheerleaders are required to ride the bus to away games. You may ride home from a game with a parent only. Cheerleaders and their parent driving them home must check in with the coach before leaving the game. B. You should arrive 15 min before the designated time and place, dressed and ready to cheer. All Cheerleaders must be in the same attire at the game. You should dress in uniform (top & skirt) with your hair pulled back in with game day bow. You are to look identical meaning you all wear skirts or warm up pants, not a mixture. This also applies for your attire to school the day of the game.

Competition:

A. Cheerleaders must attend all competitions and practices. You should arrive 15 minutes before the designated time and place, dressed and ready to compete.

B. All cheerleaders need to be dressed in their whole uniform, top, skirt, socks, shoes, hair done with competition bow.

Lettering:

Only Varsity cheerleaders can letter. To letter you must meet all of the requirements:

A. Must finish the season academically eligible and pass 5 out of 6 courses B. If cheerleaders are removed from the team or quit the team during the season, they will not receive a letter. C. Must participate in all mandatory events designated by the Coach. This includes practices during season and all games including preseason games or competitions. D. Due to specific circumstances, the requirements above may vary at the discretion of the coach.

Academics:

A. Academics come first, and cheerleaders must meet all the eligibility requirements of GHSA. Eligibility will be checked through administration at the end of each grading period.

Banquets:

A. Cheerleaders must attend the banquet for the sport for which he or she has cheered. Attendance is considered part of the lettering process.

Fundraising:

A. During the year, cheerleaders will participate in fund raising projects. Each cheerleader is expected to raise funds for its operational costs, clinics, uniforms, and other cheerleader accessories.

B. Football Cheerleaders will sponsor the Miss Auberon Pageant, and attendance is mandatory for all football cheerleaders and parents the day of the event. More details will follow.

C. Each fund-raiser will have a team minimum. Fund-raisers cover purchases such as our mats, uniforms, team building events, and possibly a portion of fees. You will be notified prior to each fund-raiser the amounts of the team minimum.

D. Parents are expected to participate in the fundraising process. You are required to be at all fundraising events unless the coach has stated otherwise.

Camp: FOOTBALL CHEER/COMP CHEER ONLY

A. Camp is not a mandatory event, but it is strongly encouraged. This is a chance for s to learn new skills, bond as a team, and participate in a spirit competition against other schools in the state.

B. All the expectations that are in this document apply while we are at camp. (Please see Consequence Policy section).

C. While we are at camp, you are to be with your team at all times. You are not permitted to wonder the campus, do campus tours, etc… while you are at the camp.

D. Dorms- while in the dorms you are to shower, complete team building activities with your coach and teammates, be in your rooms and lights out when designated by your coach. If any cheerleader is caught leaving their room to wonder the campus or meet up with anyone, they will be automatically sent home and dismissed from the team.

Cell Phone Policy:

A. Any time you are with your team, whether it be team building events, practice, games, or competitions, you are not to be on your cell phone. Your cell phones must be turned off, and they must not ring during practice, games, or competitions.

B. Break-time during games, practices, and competitions are not the time to check your phone. Your coach will allow you to call your parents in the event that practice is running late or early, etc…

Grizzly Reputation

Attitude:

A. Anytime you enter practice, games, or competitions, you must have a positive attitude. You need to leave all cares, worries, concerns, or issues at the door.

B. When you are at practice you need to have respect for all persons in the building which include ALL coaches, teammates, school officials, parents etc…

School Appearance:

A. All cheerleaders must uphold the school’s code of conduct and dress code while they are on school grounds for any reason.

B. Cheerleaders are LEADERS, and we lead by example.

Social Media:

A. All cheerleaders must have a conservative image on any social networking site. Creekview Cheer Program will not tolerate: bullying, inappropriate posts or pictures such as sex, drugs, alcohol, or profanity.

B. Rule of thumb: Don’t post anything that you don’t want your coach, parent, grandparent, or school administrator to see.

Drugs and Alcohol:

A. If a cheerleader is caught with drugs or alcohol and is given a citation, the cheerleader has 5 days to report the incident to the coach.

B. We will follow the discipline policy laid out in the Cherokee County Discipline Handbook, appendix J.

Consequence Policy

The consequence policy applies to all cheer events, school, and activities, and will be upheld by all coaches in the Creekview Cheer Program. The coaches have the right to change or bump a punishment at their discretion depending on the severity of the behavior.

Demerit System: 1st offense- Warning from Coach 2nd offense- Conditioning specified by Coach 3rd offense- Benched ½ a game or (if competition only) 3-15 min conditioning sessions before or after practice with your Coach 4th offense- Parent/Coach/ Cheerleader conference 5th offense- removal from the team **Please Note: If you quit before or during your season, then you not be able to receive a refund for any money that has been paid to any of the Creekview Cheer programs if the date of quitting is after the first order is placed. Also, you will not be eligible for the next season try-outs for the teams that you previously quit. This policy extends to each cheer team that your cheerleader is a part of. If you quit one team or both, then you will not be eligible to try-out for the next season. This also includes if your cheerleader has been removed from the team.

Agreement/Signature

Now that you have read the Creekview Cheer Constitution, you are required to follow the specified expectations and must sign below. This form must be signed by you and given to your coach to continue to try-out or participate in the Creekview Cheer Program.

By signing this document, you are agreeing to uphold the rules and expectations of this program for the entirety of the season. If for any reason you break your agreement, then you will be subject to the consequence policy or removal from the team.

__________________________________________________________ ____________________

Cheerleader’s First and Last Name (Print) Date

__________________________________________________________ _____________________

Cheerleader’s Signature Date

__________________________________________________________ ______________________

Parent Name (Print) Date

__________________________________________________________ _______________________

Parent Signature Date

1-Heart 1-Mind 1-Team

Creekview Cheer

INHERENT RISKS OF CHEERLEADING Cheerleading is a sport and with any sport there is risk of injury. Cheerleading is an anaerobic/aerobic activity that includes jumping, stunting, motions, and tumbling. All physicals must be on file in the school before the student can participate in the sport, practices or games. Coaches should be informed of any injury or chronic conditions. Although the probability of injury is minimized if you practice correctly, there is always the possibility of one occurring. Injuries that can occur in cheerleading include but are not limited to the following: blisters, muscle strains, ligament sprains, joint and muscle soreness, abrasions, contusions, stress fractures, broken bones, spinal cord injuries involving paralysis and even death. However, if you take certain precautions, the possibility of such injuries may be largely decreased. Be sure to abide by the following:

1. Never stunt or tumble unless a coach is present. 2. Always practice in the presence of a qualified coach. 3. Always warm-up appropriately before cheering (practice and games) by jogging

and stretching. 4. Do not attempt a stunt that you do not know how to perform safely and that has

not been cleared by the coach. 5. Always use attentive spotters when stunting. 6. Always use mats or a grassy area when stunting during practice. 7. Always cheer in an area free from obstructions. 8. Do not stunt on uneven ground, wet surfaces, and concrete. Do not stunt in cold

or rainy weather. 9. Never talk, laugh, or mess around when performing a stunt or learning a stunt. 10. Report injuries to the coach as soon as they occur. 11. Follow all trainer and doctor recommendations. 12. Lift weights to increase strength and guard against injuries. 13. Always wear shoes and clothing appropriate for cheerleading. 14. Never wear jewelry of any kind or chew gum when cheering including practices

and games. 15. Always have your hair pulled back from your face and shoulders. 16. Eat nutritious meals and get plenty of rest. 17. Always ask for assistance or advice at any time. 18. Do not stunt or tumble when game is in process. Or when it is not time at practice. 19. Never show off. 20. Take all activities seriously. 21. Do not participate in cheerleading if you are sick.

I have read the preceding warning. I thoroughly appreciate and understand the assumption of risks inherent in cheerleading participation. I acknowledge that I am physically fit and voluntarily participating in the activity of cheerleading. I agree to release my coaches, administrators, and school district from any and all liability. Parent: _____________________________________ Date: _____________________ Cheerleader: _________________________________ Date: ______________________

CHEROKEE COUNTY SCHOOL DISTRICT Athletic Parental Consent, Insurance, Authorization and Waiver and Release Form

2018-19 School Year

OSO/Athletics/021418

School Student ID#

Name Male Female Last First Middle Address Street City State Zip

Home# Date of Birth: Date entered 9th grade Grade Level 2018-19

Father’s Name Work# Cell# Mother’s Name Work# Cell#

Student resides with (names of Parent(s)/Guardian(s) (If Guardian, submit copies of Court Order for Guardianship)

The student is domiciled at the above address located in the ______________________________ High School District (school must be notified if student moves from the above address). Have you attended this Cherokee County School for at least one full school year? ___________

EMERGENCY CONTACT INFORMATION In the event of an emergency and the parent(s)/guardian(s) cannot be reached, please contact the following Emergency Contacts.

Name Relationship Home/Work# Cell#

Name Relationship Home/Work# Cell#

ACKNOWLEDGEMENT OF RISK AND PARENTAL CONSENT FOR PARTICIPATION

WARNING: Although participation in supervised inter-scholastic athletics and activities and intra-scholastic athletic clubs and activities may be one of the least hazardous in which students engage, BY ITS NATURE, PARTICIPATION IN INTER-SCHOLASTIC ATHLETICS AND INTRA-SCHOLASTIC SPORTS CLUBS INCLUDE A RISK OF INJURY WHICH MAY RANGE IN SEVERITY FROM MINOR TO LONG TERM CATASTROPHIC, INCLUDING PERMANENT PARALYSIS FROM THE NECK DOWN OR DEATH. Although serious injuries are not common in supervised athletic programs or athletic clubs, it is possible only to minimize, not eliminate this risk. Participants can and have the responsibility to help reduce the chance of injury. PARTICIPANTS MUST OBEY ALL SAFETEY RULES, REPORT ALL PHYSICAL PROBLEMS TO THEIR COACHES OR CLUB SUPERVISORS, FOLLOW A PROPER CONDITIONING PROGRAM AND INSPECT THEIR EQUIPMENT DAILY. By signing this Consent, you acknowledge that you have read and understand the warning. PARENTS OR STUDENTS WHO DO NOT WISH TO ACCEPT THESE RISKS DESCRIBED IN THIS WARNING SHOULD NOT SIGN THIS CONSENT FORM AND MAY NOT PARTICIPATE IN THE ACTIVITY. I/We hereby consent for _____________________________________________ to:

1. Compete in athletics at _____________________________________ School in the Cherokee County School District hereinafter (CCSD) as governed by the Georgia High School Association hereinafter (GHSA) approved sports.

2. To accompany any school team or sports club of which he/she is a member on any of its local or out of town trips. 3. I/We hereby verify that the information contained within this form is correct and understand that any false information may result in my

son/daughter being declared ineligible for participation in sports. 4. If my student is found illegally enrolled out of their school attendance zone he/she could be ruled ineligible for GHSA competition for one (1) full

year. 5. By execution hereof, I/We hereby release and forever discharge CCSD, its agents and employees from any and all liability resulting from the

intentional or negligent acts or conduct by the District, its agents and/or employees. This Acknowledgement of Risk and Consent to allow participation shall remain in effect until revoked in writing.

Signature(s) Parent(s)/Guardian(s) Date

Signature of Student Date


2018-19 School Year


INSURANCE INFORMATION Please INITIAL one of the following statements regarding insurance coverage for your student for the current school year, then sign below. _____ My student is adequately and currently covered by accident insurance that will cover injuries sustained while participating in any school authorized activity (including, but not limited to Varsity or JV Football).

Insurance Company Name of Insured Policy Number

_____ I have purchased the Benefit Plan provided by CCSD. I understand this is a supplemental policy. (A copy of this Benefit Plan should be attached)


AUTHORIZATION AND WAIVER I/We certify that the medical history on this form is complete and accurate. I/We understand that this will serve as the basis for determining that my student may compete in middle/high school athletics within CCSD. I/We also understand this medical evaluation is general in nature and only performed to determine fitness for athletics and is not to take place of regular medical examinations. In case of an emergency or accident on/off school grounds during any school activity or athletic event, which in the opinion of school authorities present requires immediate medical or surgical attention, I/we hereby grant permission to physicians, consulting physicians, certified athletic trainers, emergency medical technicians, and other healthcare providers selected by school authorities to provide medical care and treatment (including hospitalization if deemed necessary) unless I am present and request otherwise or until I later request otherwise. I/We understand that the terms hereof apply to any injury, illness or other medical problem or emergency that arises as a result of or in connection with any aspect of athletic participation for CCSD, including tryouts, practice, conditioning, meetings, games, and/or travel. I/We also understand that reasonable efforts will be made to contact parent(s) or legal guardian(s) before any serious or involved medical treatment. I/We understand that per GHSA, a Pre-Participation Physical Evaluation must be performed by a physician to medically screen each student who participates in the athletic program(s) of CCSD. I/We further understand that a basic medical screening (the required physical exam) is general in nature and limited in its scope and does not indicate or assure me that my student is completely free from impairments. If I/we wish for a more detailed physical exam to be performed upon my student, then it is my responsibility to arrange and pay for such an exam. If this more detailed exam is performed, it is my responsibility to notify CCSD and its appropriate employees, of any potential medical problems uncovered by any physical exam given to my student other than the general physical required by the school system for athletic participation. I/We assume all liability and responsibility for any and all potential or real risks, injuries or even death which may result from Student’s participation in inter-scholastic athletics, sports teams/clubs and events. I/We represent and warrant that I/we know of no mental or physical condition that would make it unsafe for Student to participate in inter-scholastic athletics, sports teams/clubs and events. I/We understand, acknowledge and agree that CCSD shall not be liable for any injury/illness suffered by the Student which arises out of and/or is associated with preparing for and/or participating in inter-scholastic athletics, sports teams/clubs and events. I/We hereby release, discharge, indemnify, and agree to hold harmless CCSD, Members of the CCSD Board of Education, its past, present and future officers, attorneys, agents, employees, predecessors and successors in interest, and assigns, hereinafter “CCSD Releasees”, from any and all liability arising out of or in connection with Student’s participation in inter-scholastic athletics, sports team/clubs and events. For purpose of this Release, liability means all claims, demands, losses, causes of action, suits, or judgements of any kind that Student or Student’s parents, guardians, heirs, executors, administrators, and assigns have or may have against the CCSD Releasees because of Student’s personal, physical, or emotional injury, accident, illness or death, or because of any loss of or damage to property that occurs to Student or his or her property including Student’s participation in inter-scholastic athletics, sports teams/clubs and events due to acts of passive or active negligence by CCSD Releasees other than actions involving fraud or actual malice. By signing below, I/we acknowledge that I/we have carefully read this voluntary Waiver and understand the potential dangers incident to engaging in inter-scholastic athletics, sports teams/clubs and events, and are fully aware of the legal consequences of this agreement.


Signature of Student Date THIS ACKNOWLEDGEMENT OF AUTHORIZATION AND WAIVER SHALL REMAIN IN EFFECT UNTIL REVOKED IN WRITING.



2018-19 School Year


STUDENT TRANSPORTATION RELEASE AND CONSENT FORM

While CCSD provides transportation through the utilization of the District bus fleet for many extracurricular events, in some cases school sponsored transportation is not available. In those instances, it is necessary for the parent/guardian to make arrangements for transportation. CCSD discourages students from riding with other students to and from extracurricular events. I/We, ___________________________________________, parent/guardian of _____________________________________________(student) hereby give my/our permission for my student to provide his/her own transportation to/from extracurricular events, and I/we, parent/guardian of the student listed above, hereby give my permission for my/our student to ride with another parent. I/We hereby consent on behalf of the student named to participate in school-sponsored trips. I/We understand that transportation may or may not be provided by CCSD. In the event transportation is not provided by CCSD, transportation will be the student’s and parent(s)/guardian(s) responsibility.


RELEASE OF INFORMATION TO MEDIA AND COLLEGES

I/We hereby authorize the release of any and all information relating to the athletic participation of the above-named student to the media and to all college recruiters, including any medical information concerning injury or illness, any biographical information, and any other information related to the athletic participation, including ability, attitude and conduct.


GUIDELINES FOR OUTDOOR EXTRACURRICULAR ACTIVITIES DURING EXTREME HOT AND HUMID WEATHER I/We hereby verify that I/we have received and reviewed the CCSD Guidelines for Outdoor Extracurricular Activities During Extreme Hot and Humid Weather.


STUDENT ATHLETE CONCUSSION AWARENESS, DIAGNOSIS AND MANAGEMENT PROGRAM (GHSA 02.18)

DANGERS OF CONCUSSION

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. Refer to it regularly. This form must be signed by a parent or guardian of each student who wishes to participate in GHSA athletics. One copy needs to be returned to the school, and one retained at home.

COMMONS SIGNS AND SYMPTOMS OF CONCUSSION

• Headache, dizziness, poor balance, moves clumsily, reduced energy level/tiredness • Nausea or vomiting • Blurred vision, sensitivity to light and sounds • Fogginess of memory, difficulty concentrating, slowed thought processes, confused about surroundings or game assignments • Unexplained changes in behavior and personality • Loss of consciousness (NOTE: This does not occur in all concussion episodes.)

BY-LAW 2.68: GHSA CONCUSSION POLICY: In accordance with 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.

a) 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.


2018-19 School Year


b) 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.

By signing this concussion form, I/we give ___________________________ High School permission to transfer this concussion form to the other sports that my child may play. I am aware of the dangers of concussion and this signed concussion form will represent myself and my child during the 2018-19 school year. This form will be stored with the athletic physical form and other accompanying forms required by CCSD. By signing this concussion form, I/we give High School permission to transfer this concussion form to the other sports that my child may play. I am aware of the dangers of concussion and this signed concussion form will represent myself and my child during the 2018-2019 school year. This form will be stored with the athletic physical form and other accompanying forms required by CCSD.

I/We have read the information concerning usage of the Immediate Post-Concussion Assessment and Cognitive Test (ImPACT™) and understand its contents. I/We have been given an opportunity to ask questions and all have been answered to my satisfaction. I/We understand that participation in the ImPACT™ concussion baseline testing is highly recommended and required for athletes in Cherokee County schools. I/We also understand that the ImPACT™ testing is merely a tool to assist Medical Professionals in the diagnosis and subsequent treatment of potentially serious injuries, the ImPACT™ testing IS NOT a substitute for treatment by a Medical Professional. I/We acknowledge that if my/our child is suspected of receiving a concussion causing injury, my/our child WILL NOT be allowed to participate in athletics until cleared by a medical doctor.



■ Preparticipation Physical Evaluation HISTORY FORM

(Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.)

Date of Exam ___________________________________________________________________________________________________________________

Name __________________________________________________________________________________ Date of birth __________________________

Sex _______ Age __________ Grade _____________ School _____________________________ Sport(s) __________________________________

Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking

Do you have any allergies? � Yes � No If yes, please identify specific allergy below. � Medicines � Pollens � Food � Stinging Insects

Explain “Yes” answers below. Circle questions you don’t know the answers to.

GENERAL QUESTIONS Yes No

1. Has a doctor ever denied or restricted your participation in sports for any reason?

2. Do you have any ongoing medical conditions? If so, please identify below: � Asthma � Anemia � Diabetes � InfectionsOther: _______________________________________________

3. Have you ever spent the night in the hospital?

4. Have you ever had surgery?

HEART HEALTH QUESTIONS ABOUT YOU Yes No5. Have you ever passed out or nearly passed out DURING or

AFTER exercise?

6. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?

7. Does your heart ever race or skip beats (irregular beats) during exercise?

8. Has a doctor ever told you that you have any heart problems? If so, check all that apply: � High blood pressure � A heart murmur� High cholesterol � A heart infection� Kawasaki disease Other: _____________________

9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, echocardiogram)

10. Do you get lightheaded or feel more short of breath than expected during exercise?

11. Have you ever had an unexplained seizure?

12. Do you get more tired or short of breath more quickly than your friends during exercise?

HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No13. Has any family member or relative died of heart problems or had an

unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)?

14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia?

15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator?

16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?

BONE AND JOINT QUESTIONS Yes No17. Have you ever had an injury to a bone, muscle, ligament, or tendon

that caused you to miss a practice or a game?

18. Have you ever had any broken or fractured bones or dislocated joints?

19. Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace, a cast, or crutches?

20. Have you ever had a stress fracture?

21. 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)

22. Do you regularly use a brace, orthotics, or other assistive device?

23. Do you have a bone, muscle, or joint injury that bothers you?

24. Do any of your joints become painful, swollen, feel warm, or look red?

25. Do you have any history of juvenile arthritis or connective tissue disease?

MEDICAL QUESTIONS Yes No26. Do you cough, wheeze, or have difficulty breathing during or

after exercise?

27. Have you ever used an inhaler or taken asthma medicine?

28. Is there anyone in your family who has asthma?

29. Were you born without or are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ?

30. Do you have groin pain or a painful bulge or hernia in the groin area?

31. Have you had infectious mononucleosis (mono) within the last month?

32. Do you have any rashes, pressure sores, or other skin problems?

33. Have you had a herpes or MRSA skin infection?

34. Have you ever had a head injury or concussion?

35. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

36. Do you have a history of seizure disorder?

37. Do you have headaches with exercise?

38. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling?

39. Have you ever been unable to move your arms or legs after being hit or falling?

40. Have you ever become ill while exercising in the heat?

41. Do you get frequent muscle cramps when exercising?

42. Do you or someone in your family have sickle cell trait or disease?

43. Have you had any problems with your eyes or vision?

44. Have you had any eye injuries?

45. Do you wear glasses or contact lenses?

46. Do you wear protective eyewear, such as goggles or a face shield?

47. Do you worry about your weight?

48. Are you trying to or has anyone recommended that you gain or lose weight?

49. Are you on a special diet or do you avoid certain types of foods?

50. Have you ever had an eating disorder?

51. Do you have any concerns that you would like to discuss with a doctor?

FEMALES ONLY52. Have you ever had a menstrual period?

53. How old were you when you had your first menstrual period?

54. How many periods have you had in the last 12 months?

Explain “yes” answers here

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

Signature of athlete __________________________________________ Signature of parent/guardian ____________________________________________________________ Date _____________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.HE0503 9-2681/0410

■ Preparticipation Physical Evaluation THE ATHLETE WITH SPECIAL NEEDS: SUPPLEMENTAL HISTORY FORM

Date of Exam ___________________________________________________________________________________________________________________


Sex _______ Age __________ Grade _____________ School _____________________________ Sport(s) __________________________________

1. Type of disability

2. Date of disability

3. Classification (if available)

4. Cause of disability (birth, disease, accident/trauma, other)

5. List the sports you are interested in playing

Yes No6. Do you regularly use a brace, assistive device, or prosthetic?

7. Do you use any special brace or assistive device for sports?

8. Do you have any rashes, pressure sores, or any other skin problems?

9. Do you have a hearing loss? Do you use a hearing aid?

10. Do you have a visual impairment?

11. Do you use any special devices for bowel or bladder function?

12. Do you have burning or discomfort when urinating?

13. Have you had autonomic dysreflexia?

14. Have you ever been diagnosed with a heat-related (hyperthermia) or cold-related (hypothermia) illness?

15. Do you have muscle spasticity?

16. Do you have frequent seizures that cannot be controlled by medication?


Please indicate if you have ever had any of the following.

Yes NoAtlantoaxial instability

X-ray evaluation for atlantoaxial instability

Dislocated joints (more than one)

Easy bleeding

Enlarged spleen

Hepatitis

Osteopenia or osteoporosis

Difficulty controlling bowel

Difficulty controlling bladder

Numbness or tingling in arms or hands

Numbness or tingling in legs or feet

Weakness in arms or hands

Weakness in legs or feet

Recent change in coordination

Recent change in ability to walk

Spina bifida

Latex allergy


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

Signature of athlete __________________________________________ Signature of parent/guardian __________________________________________________________ Date _____________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

■ Preparticipation Physical Evaluation PHYSICAL EXAMINATION FORM


PHYSICIAN REMINDERS1. Consider additional questions on more sensitive issues

• Do you feel stressed out or under a lot of pressure?• Do you ever feel sad, hopeless, depressed, or anxious?• Do you feel safe at your home or residence?• Have you ever tried cigarettes, chewing tobacco, snuff, or dip?• During the past 30 days, did you use chewing tobacco, snuff, or dip?• Do you drink alcohol or use any other drugs?• Have you ever taken anabolic steroids or used any other performance supplement?• Have you ever taken any supplements to help you gain or lose weight or improve your performance?• Do you wear a seat belt, use a helmet, and use condoms?

2. Consider reviewing questions on cardiovascular symptoms (questions 5–14).

EXAMINATIONHeight Weight � Male � Female

BP / ( / ) Pulse Vision R 20/ L 20/ Corrected � Y � NMEDICAL NORMAL ABNORMAL FINDINGSAppearance• Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum, arachnodactyly,

arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency)Eyes/ears/nose/throat• Pupils equal• HearingLymph nodesHeart a

• Murmurs (auscultation standing, supine, +/- Valsalva)• Location of point of maximal impulse (PMI)Pulses• Simultaneous femoral and radial pulsesLungsAbdomenGenitourinary (males only)b

Skin• HSV, lesions suggestive of MRSA, tinea corporisNeurologic c

MUSCULOSKELETALNeckBackShoulder/armElbow/forearmWrist/hand/fingersHip/thighKneeLeg/ankleFoot/toesFunctional• Duck-walk, single leg hop

aConsider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam.bConsider GU exam if in private setting. Having third party present is recommended. cConsider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.

��Cleared for all sports without restriction

��Cleared for all sports without restriction with recommendations for further evaluation or treatment for _________________________________________________________________

____________________________________________________________________________________________________________________________________________

��Not cleared

��Pending further evaluation

��For any sports

��For certain sports _____________________________________________________________________________________________________________________

Reason ___________________________________________________________________________________________________________________________

Recommendations _________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If condi-tions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Name of physician (print/type) _____________________________________________________________________________________________________ Date ________________

Address ___________________________________________________________________________________________________________ Phone _________________________

Signature of physician _______________________________________________________________________________________________________________________, MD or DO

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.HE0503 9-2681/0410

■ Preparticipation Physical Evaluation CLEARANCE FORM

Name ___ ____________________________________________________ Sex ��M ��F Age _________________ Date of birth _________________

��Cleared for all sports without restriction

��Cleared for all sports without restriction with recommendations for further evaluation or treatment for _______________________________________________

___________________________________________________________________________________________________________________________

��Not cleared

��Pending further evaluation

��For any sports

��For certain sports _____________________________________________________________________________________________________

Reason ___________________________________________________________________________________________________________

Recommendations _______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If conditions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Name of physician (print/type) ___________________________________________________________________________________ Date ________________

Address _________________________________________________________________________________________ Phone _________________________

Signature of physician _____________________________________________________________________________________________________, MD or DO

EMERGENCY INFORMATION

Allergies ______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

Other information _______________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.

Appendix J: Student Activity Code of Conduct I. Introduction

The Cherokee County School District has determined that participation in interscholastic/extracurricular activities is a privilege for students enrolled in the School District. A student participating in such activities is considered to be a school leader; and, with leadership comes additional responsibility, so students must adhere to the standards and expectations contained in the School District’s Activity Code of Conduct. As such, if a student violates these standards, schools may withdraw the privilege of participating in these activities, regardless of whether the violation occurred at a school-related or non-school-related activity. Schools may also withdraw the privilege of participating in these activities if the student violations occur outside of the scope of the activity’s “season”; or, beyond the scope of the school day/year.

II. Student Infractions and Standards of Behavior

Student Infractions: Any student who commits the following infractions may be suspended or permanently dismissed from the team:

1.) Hazing other students—school clubs and student organizations will not use hazing or degradation of individual dignity;

2.) Missing practice, rehearsal or activities (unless excused by the coach or sponsor); 3.) Truancy and/or skipping classes; 4.) Acting in an unsportsmanlike manner when representing the school; 5.) Violating team curfews (as established by the coach or sponsor); 6.) Any behavior which results in discipline by the school administration; and 7.) Any behavior which, in the opinion of the administration, reflects in a negative manner on

the team, activity, athletic program or school. Standards and Expectations for Behavior: Students participating in interscholastic/extracurricular activities must comply with the following standards and expectations for behavior:

1.) Establishing and promoting a positive self-image for the program, school and School District. 2.) Exhibiting good sportsmanship. 3.) Supporting team/activity rules developed by the activity’s coaches or sponsors. 4.) Adhering to the School District’s Student Discipline Code. 5.) Observing all standards and guidelines established by the Georgia High School Association

(GHSA) Constitution and by-laws. 6.) Obeying local, State and Federal laws governing behavior and conduct.*

Note: Provisions for dealing with starred (*) items above are contained in Section V of this document.

III. Dispositions for Student Infractions and Standards of Behavior Dispositions for student infractions and violations of standards and expectations of behavior include, but are not limited to, the following:

▪ Additional practice or conditioning time ▪ Conferencing between sponsor/parent or sponsor/student athlete ▪ Loss of position or awards privileges ▪ Suspension and/or removal from team

IV. Suspensions for Student Infractions and Standards of Behavior

Applying Suspensions: Relative to suspensions, progressive discipline processes will be utilized in order to create the expectation that the degree of discipline will be in proportion to the severity of the behavior, as well as consideration given to each student’s previous discipline history and other relative factors.

1st Offense: Amount of suspension will be at the discretion of the Principal 2nd Offense: Suspension will be a minimum of twice the suspension for the first offense 3rd Offense: Permanent suspension

Reporting Suspensions: Parent/guardian will be notified of the student’s suspension. A suspension report will be filed with the Office of Student Activities and Athletics.

Transferring of Suspended Student Athletes: Students suspended from activities will not regain eligibility by transferring to another school within the School District.

V. Dealing with Student Arrests

Reporting of Misdemeanor or Felony Arrests: A student (or his/her parent/guardian) is responsible for informing a school official, which may include the Principal, Athletic Director or his/her Head Coach or sponsor, of misconduct which results in a misdemeanor or felony arrest. This report must occur within five calendar days of the arrest or the student faces disciplinary action up to, and including, partial or permanent suspension.

Confirming Student Arrests: Student arrests that are verified through a reliable source (school administrator, teacher, coach/sponsor, staff member, parent of involved student, School District Police Department, etc.) will be appropriately investigated by the school administration or designee.

Investigations arising from student arrests will be reviewed by a panel comprised of staff from the offending student’s school, to include, but not be limited to the following: a school administrator, the school’s athletic director, the coach/sponsor of the student, one additional coach/sponsor (as selected by the Principal), and one teacher (as selected by the Principal). It will be the role of this panel to review all information available as a result of the investigation and recommend potential dispositions for any confirmed infraction to the Principal for his/her consideration—it will ultimately be the responsibility of the Principal to administer discipline. The student may present a written response to the alleged infractions being presented to the panel, but the student will not be present at the panel hearing. The student’s parent/guardian will be notified in writing of the panel’s decisions.

The school reserves the right to suspend and/or permanently dismiss a student from all extracurricular/interscholastic programs for the remainder of their school career for misconduct, which could result in the arrest or conviction of select misdemeanor or felony crimes.

Addressing Felony Arrests and/or Convictions: Felony arrests constitute an immediate suspension from activities. Relative to that arrest, any subsequent felony conviction of a student may result in a permanent dismissal from activities.

Addressing Misdemeanor Arrests and/or Convictions: Misdemeanor arrests and/or convictions that will cause suspensions from activities may include, but are not limited to, the following areas:

▪ Disruption of school or school events ▪ Threats of violence or acts of violence against school employees or students ▪ Sexual Offenses ▪ Weapons Offenses ▪ Alcohol or Drug Offenses

VI. Duration of Code of Conduct

The Student Activity Code of Conduct will be in effect year-round.



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