Sports Agreement & Permission Form

This form includes the following sections:

1. STUDENT/FAMILY INFORMATION
2. PERMISSION TO PARTICIPATE AND TRAVEL
3. CODE OF ETHICS
4. DECLARATION ON THE USE OF STEROIDS
5. PARENT AND STUDENT-ATHLETE CONCUSSION INFORMATION SHEET
6. ASSUMPTION OF RISK, WAIVER AND RELEASE OF LIABILITY, AND INDEMNIFICATION AGREEMENT
7. MEDICAL EXAM FORM (upload image or pdf)

Please provide the contact information for the parent who will be the primary contact for the team manager.

If another parent or guardian would like to be on the team's contact list, please provide the additional information below.

By signing below, I give permission for the named child to participate in trips and away games for ANY competitive sports that he/she competes in during that sport’s season.  I also acknowledge that unless buses are provided, I am responsible for transporting the named child to and from away games and/or arranging how the named child will travel to and from away games.

Athletics is an integral part of the school’s total education program. All school activities, curricular and extracurricular in the classroom and on the playing field, must be congruent with the school’s stated goals and objectives established for the intellectual, social, and moral development of its students. It is within this context that the following code of ethics is presented.

By signing below, I understand it is my responsibility as a student-athlete to:

1. Place academic achievement as the highest priority.
2. Show respect for teammates, opponents, officials and coaches.
3. Respect the integrity and judgment of game officials.
4. Exhibit fair play, sportsmanship, and proper conduct on and off the playing field.
5. Maintain a high level of safety awareness.
6. Refrain from the use of profanity, vulgarity, and other offensive language and gestures.
7. Adhere to the established rules and standards of the game to be played.
8. Respect all equipment and use it safely and appropriately.
9. Refrain from the use of alcohol, tobacco, illegal and non-prescriptive drugs, anabolic steroids or any substance to increase physical development or performance that is not approved by the United States Food and Drug Administration, Surgeon General of the United States or American Medical Association.
10. Know and follow all state, section and school athletic rules and regulations as they pertain to eligibility and sports participation.
11. Win with character, lose with dignity.

By signing below, we agree that the named child shall abide by the SPMS Athlete Code of Ethics and also not use androgenic/anabolic steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition. We also recognize there could be penalties for false or fraudulent information and understand the South Pasadena Unified School District’s policy regarding the use of illegal drugs will be enforced for any violations of these rules.

WHAT IS A CONCUSSION? 

A concussion is a type of traumatic brain injury that changes the way the brain normally works. A concussion is caused by a bump, blow, or jolt to the head or body that causes the head and brain to move quickly back and forth.  Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. 

WHAT ARE THE SIGNS AND SYMPTOMS OF CONCUSSION?

Signs and symptoms of concussion can show up right after the injury or may not appear or be noticed until days or weeks after the injury.  If an athlete reports one or more symptoms of concussion after a bump, blow, or jolt to the head or body, s/he should be kept out of play the day of the injury.  The athlete should only return to play with permission from a health care professional experienced in evaluating for concussion. 

DID YOU KNOW?  

• Most concussions occur without loss of consciousness.
• Athletes who have, at any point in their lives, had a concussion have an increased risk for another concussion.
• Young children and teens are more likely to get a concussion and take longer to recover than adults. 

SYMPTOMS REPORTED BY ATHLETE: 

• Headache or “pressure” in head
• Nausea or vomiting
• Balance problems or dizziness
• Double or blurry vision 
• Sensitivity to light
• Sensitivity to noise 
• Feeling sluggish, hazy, foggy, or groggy
• Concentration or memory problems 
• Just not “feeling right” or is “feeling down”
• Confusion 

SIGNS OBSERVED BY COACHING STAFF: 

• Appears dazed or stunned
• Is confused about assignment or position 
• Forgets an instruction
• Is unsure of game, score, or opponent 
• Moves clumsily
• Answers questions slowly 
• Loses consciousness (even briefly)
• Shows mood, behavior, or personality changes 
• Can’t recall events prior to hit or fall
• Can’t recall events after hit or fall 

CONCUSSION DANGER SIGNS 

In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull.  An athlete should receive immediate medical attention if after a bump, blow, or jolt to the head or body, he or she exhibits any of the following danger signs:

• One pupil larger than the other
• Is drowsy or cannot be awakened 
• A headache that gets worse
• Weakness, numbness, or decreased coordination 
• Repeated vomiting or nausea
• Slurred speech 
• Convulsions or seizures
• Cannot recognize people or places 
• Has unusual behavior
• Becomes increasingly confused, restless, or agitated
• Loses consciousness (even a brief loss of consciousness should be taken seriously) 

WHAT SHOULD YOU DO IF YOU THINK YOUR ATHLETE HAS A CONCUSSION? 

If you suspect that an athlete has a concussion, remove the athlete from play and seek medical attention.  Do not try to judge the severity of the injury yourself.  Keep the athlete out of play the day of the injury and until a healthcare professional, experienced in evaluating for concussion, says the athlete is symptom-free and is okay to return to play.

Rest is key to helping an athlete recover from a concussion.  Exercising or activities that involve a lot of concentration, such as studying, working on the computer, and playing video games, may cause concussion symptoms to reappear or get worse.  After a concussion, returning to sports and school is a gradual process that should be carefully managed and monitored by a health care professional.

Remember:  Concussions affect people differently.  While most athletes with a concussion recover quickly and fully, some will have symptoms that last for days, or even weeks.  A more serious concussion can last for months or longer. 

WHY SHOULD AN ATHLETE REPORT THEIR SYMPTOMS? 

If an athlete has a concussion, his/her brain needs time to heal.  While an athlete’s brain is still healing, he or she is much more likely to have another concussion.  Repeat concussions can increase the time it takes to recover. In rare cases, repeat concussions in young athletes can result in brain swelling or permanent damage to their brain.  They can even be fatal.

***

“IT’S BETTER TO MISS ONE GAME THAN THE WHOLE SEASON” 
 

This information sheet is also available at the the following website:

https://www.cdc.gov/headsup/pdfs/custom/headsupconcussion_parent_athlete_info.pdf

By signing below, I assume all risks of my child participating in South Pasadena Middle School’s athletic program’s activities and acknowledge that competitive athletics, by their very nature, may put students in situations in which serious, catastrophic and perhaps fatal accidents may occur. I undertake and assume this risk for myself and my child.  I also acknowledge the importance of the named child following instructions from the coaching staff in regards to playing techniques, training, equipment, and team rules, both at practice and during competition.  Without signing this form, my child will be unable to participate in these activities.

By signing below, I further waive and release the South Pasadena Middle School Athletic Booster Club (hereinafter “club”), the school facility, any insuring entity of the above, and their directors, board members, officers, employees, volunteers, agents, representatives, or assigns, as well as the activities’ sponsors, from any and all liability, including, but not limited to, liability arising from negligence or fault of the entities or persons for any injury or disability which may occur as a result of my or my child’s participation in the program’s activities or during travel to these activities.  I am assuming all risks on behalf of myself and my child that may arise from negligence or carelessness on the part of any of the persons or entities being released, as well as from defective equipment, real property or personal property that is owned, maintained or controlled by the above persons.

By signing below, I certify that my child is physically fit and sufficiently prepared for participation in such activities.  I have not been advised of any reason or health-related problems which would limit my child from participating in the activities.

By signing below, I consent to receive any medical treatment deemed advisable for an injury to my child during the activities and that any medical or other insurance for my child will be insurance of first resort before contribution by any other insurance for any other person or entity, including accidental death and dismemberment insurance and accident medical insurancBy signing below, I acknowledge that my child may be photographed while participating in the activities.  I agree to allow photographs, video, and/or film likenesses be used for any legitimate purpose by the club, promoters of the activity, school facility,  and their assigns. 

By signing below, I agree to defend, hold harmless, and indemnify the club and all other parties from and against all losses, claims, damages, costs or expenses (including reasonable legal fees, or similar costs) in connection with any action or claim brought or made (or threatened to be brought or made), for, or on account of any injuries or damages, received or sustained by my child arising during the course of the activities. 

I have read the Agreement, fully understand its terms, and understand that I am giving up substantial rights, including the right to sue.  I acknowledge I am signing the Agreement freely and voluntarily.

Click HERE to download a blank Medical Exam Form