SPORTS PARTICIPATION

Assumption of the Risk and Waiver of Liability 

READ THIS FORM COMPLETELY AND CAREFULLY. YOU ARE AGREEING TO LET YOUR MINOR CHILD ENGAGE IN A POTENTIALLY DANGEROUS ACTIVITY. YOU ARE AGREEING THAT, EVEN IF THE VICTORY CHARTER SCHOOLS (VCS) USES REASONABLE CARE IN PROVIDING THIS ACTIVITY, THERE IS A CHANCE YOUR CHILD MAY BE SERIOUSLY INJURED OR KILLED BY PARTICIPATING IN THIS ACTIVITY BECAUSE THERE ARE CERTAIN DANGERS INHERENT IN THE ACTIVITY WHICH CANNOT BE AVOIDED OR ELIMINATED. BY SIGNING THIS FORM, YOU ARE AGREEING THAT YOUR CHILD IS PHYSICALLY AND MENTALLY CAPABLE AND ELIGIBLE TO PARTICIPATE IN THIS SPORTS ACTIVITY AND IS FREE FROM INJURIES. BY SIGNING THIS FORM, YOU ARE AGREEING IN GIVING UP YOUR CHILD’s RIGHT AND YOUR RIGHT TO RECOVER FROM THE VICTORY CHARTER SCHOOLS IN A LAWSUIT FOR ANY PERSONAL INJURY, INCLUDING DEATH, TO YOUR CHILD OR ANY PROPERTY DAMAGE THAT RESULTS FROM THE RISKS THAT ARE A NATURAL PART OF THE ACTIVITY. IT INCLUDES TRAVELING LOCALLY, OUT OF STATE, AND OUT OF THE COUNTRY. YOU HAVE THE RIGHT TO REFUSE TO SIGN THIS FORM, AND VCS HAS THE RIGHT TO REFUSE TO LET YOUR CHILD PARTICIPATE IF YOU DO NOT SIGN THIS FORM.

AGREE (Required)* 

Name of Student-Athlete:   First Name*   Last Name*   

Signature of Student-Athlete: Signature*  
Date:   Date*   

Name of Parent/Guardian:   First Name*   Last Name*   
Signature of Parent/Guardian:   Signature*   
Date:   Date*   

Acknowledgment of Insurance Coverage or Waiver Verification

I understand that The Victory Charter Schools are not responsible for any medical expenses that might result from injuries to my child while representing the school athletic competition and practice sessions.

Student/Athlete Name:   First Name*   Last Name*   

Parent(s)/Legal Guardian Name:   First Name*   Last Name*   

Please provide all phone numbers on how you can be reached in the event of an emergency during practice and or game hours:

Home:   Area Code*   Phone Number*   

Cell:   Area Code*   Phone Number*   

Work:   Area Code*   Phone Number*   

Emergency:   Area Code*   Phone Number*   

I do not have insurance coverage for my child for injuries that may result from participation in athletics while representing Victory Charter Schools. I have acknowledged the Assumption of the Risk and Waiver of Liability.    I have adequate insurance coverage for my child for injuries that may result from participation in athletics while representing Victory Charter Schools.*   

Emergency Treatment Authorization

The purpose of this notice is to enable you to authorize the provision of emergency treatment for your child who may become ill or injured while under school authority when you cannot be reached. When a principal, teacher or a Coaches is unable to reach you in the event that your child is injured in an accident or becomes seriously ill, they may call the Emergency Medical Services (EMS) and all costs directed to you. 

I have read and understand this notice and give my consent for EMS to be called and emergency medical treatment to be given to my child if a medical emergency involving my child occurs while under school authority.

Acknowledged*      

Consent and Release from Liability Certificate for Concussion

Concussion Information

What is a concussion? 

A concussion is a brain injury. Concussions, as well as all other head injuries, are serious. They can be caused by a bump, a twist of the head, sudden deceleration or acceleration, a blow or jolt to the head, or by a blow to another part of the body with force transmitted to the head. You can’t see a concussion, and more than 90% of all concussions occur without loss of consciousness. Signs and symptoms of concussion may show up right after the injury or can take hours or days to fully appear. All concussions are potentially serious and, if not managed properly, may result in complications including brain damage and, in rare cases, even death. Even a “ding” or a bump on the head can be serious. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, your child should be immediately removed from play, evaluated by a medical professional and cleared by a medical doctor. What are the signs and symptoms of concussion? Concussion symptoms may appear immediately after the injury or can take several days to appear. Studies have shown that it takes on average 10-14 days or longer for symptoms to resolve and, in rare cases or if the athlete has sustained multiple concussions, the symptoms can be prolonged. Signs and symptoms of concussion can include: (not all-inclusive)

• Vacant stare or seeing stars 

• Lack of awareness of surroundings 

• Emotions out of proportion to circumstances (inappropriate crying or anger) 

• Headache or persistent headache, nausea, vomiting 

• Altered vision 

• Sensitivity to light or noise  

• Delayed verbal and motor responses 

• Disorientation, slurred or incoherent speech 

• Dizziness, including light-headedness, vertigo (spinning) or loss of equilibrium 

  (being off balance or swimming sensation) 

• Decreased coordination, reaction time 

• Confusion and inability to focus attention

• Memory loss  

• Sudden change in academic performance or drop in grades 

• Irritability, depression, anxiety, sleep disturbances, easy fatigability 

• In rare cases, loss of consciousness 

What can happen if my child keeps playing with a concussion or returns too soon?Athletes with signs and symptoms of concussion should be removed from activity (play or practice) immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to sustaining another concussion. Athletes who sustain a second concussion before the symptoms of the first concussion have resolved, and the brain has had a chance to heal are at risk for prolonged concussion symptoms, permanent disability, and even death (called “Second Impact Syndrome,” where the brain swells uncontrollably). There is also evidence that multiple concussions can lead to long-term symptoms, including early dementia. 

What do I do if I suspect my child has suffered a concussion? 

Any athlete suspected of suffering a concussion should be removed from the activity immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how mild it seems or how quickly symptoms clear, without written medical clearance from an appropriate health-care professional (AHCP). In Florida, an appropriate health-care professional (AHCP) is defined as either a licensed physician (MD, as per Chapter 458, Florida Statutes), or a licensed osteopathic physician (DO, as per Chapter 459, Florida Statutes). Close observation of the athlete should continue for several hours. You should also seek medical care and inform your child’s coach if you think that your child may have a concussion. Remember, it’s better to miss one game than to have your life changed forever. When in doubt, sit them out. 

When can my child return to play or practice?

Following physician evaluation, the return to activity process requires the athlete to be completely symptom-free, after which time they would complete a step-wise protocol under the supervision of a licensed athletic trainer, coach, or medical professional and then receive written medical clearance from an AHCP.

Statement of Student-Athlete Responsibility 

I accept responsibility for reporting all injuries and illnesses to my parents, team doctor, athletic trainer, or coaches associated with my sport, including any signs and symptoms of CONCUSSION. I have read and understand the above information on concussions. I will inform the supervising coach, athletic trainer, or team physician immediately if I experience any of these symptoms or witness a teammate with these symptoms. Furthermore, I have been advised of the dangers of participation for myself and that of my child/ward.

For current and up-to-date information on concussions, visit: https://www.cdc.gov/headsup/youthsports/index.html.

Acknowledged*      

Consent and Release from Liability for Heat-Related Illnesses

Heat-Related Illnesses Information

Who suffers heat-related illness?

People suffer heat-related illness when their bodies cannot properly cool themselves by sweating. Sweating is the body’s natural air conditioning, but when a person’s body temperature rises rapidly, sweating just isn’t enough. Heat-related illnesses can be serious and life threatening. Very high body temperatures may damage the brain or other vital organs, and can cause disability and even death. Heat-related illnesses and deaths are preventable. 

Heat Stroke is the most serious heat-related illness. It happens when the body’s temperature rises quickly and it cannot cool down. Heat Stroke can cause permanent disability and death. 

Heat Exhaustion is a milder type of heat-related illness. It usually develops after a number of days in high-temperature weather and not drinking enough fluids.

Heat Cramps usually affect people who sweat a lot during demanding activities. Sweating reduces the body’s salt and moisture and can cause painful cramps, usually in the abdomen, arms, or legs. Heat cramps may also be a symptom of heat exhaustion.

Who’s at Risk? Those at highest risk include the elderly, the very young, people with mental illness, and people with chronic diseases. However, even young and healthy individuals can succumb to heat if they participate in demanding physical activities during hot weather. Other conditions that can increase your risk for heat-related illness include obesity, fever, dehydration, poor circulation, sunburn, and prescription drug or alcohol use.

By signing this agreement, the undersigned acknowledges that the information on the document has been read and understood.

Acknowledged*         

Victory Charter Schools Photography/Video Release

CHECK APPROPRIATE BOX

For a minor under the age of 18    Accept          Do not Accept*      

I, the undersigned, hereby consent to the use by Victory Charter Schools (VCS) in Kissimmee, and those acting with permission and authority of VCS, of all photographs, videotape, or other images or recordings that VCS has taken of me or my child(s), or in which we may be included, for all purposes, in any and all media including the Internet, without limitation, including promotion, solicitation, advertising or trade. I am fully aware that my likeness may appear in materials available to students, parents, faculty or staff of VCS and individuals outside of the VCS community. I hereby waive any right to inspect or approve the finished images or other content, including advertising copy or printed matter, in which they may be used. I understand that any distribution of the images will be fully compliant with VCS policies, statements, and values. I release VCS and those acting under their authority from any liability related to the alteration, intentional or otherwise, that may occur in connection with the processing, editing, transmission, display, or publication of the images, and I understand that images may be cropped or altered for purposes of illustration. I understand that all images in which my child(s) or I participate, including film, photographic prints, digital files, or video are the exclusive property of VCS, and I grant to VCS the unrestricted right to copyright, publish and republish the images.

   

Victory Charter Schools

Student/Parent Sudden Cardiac Arrest Awareness Form

1: Learn the Early Warning Signs 

If you or your child has had one or more of these signs, see your primary care physician: 

• Fainting suddenly and without warning, especially during exercise or in response to loud sounds like doorbells, alarm clocks, or ringing phones

• Unusual chest pain or shortness of breath during exercise

• Family members who had sudden, unexplained, and unexpected death before age 50

• Family members who have been diagnosed with the condition that can cause sudden cardiac death, such as hypertrophic cardiomyopathy (HCM) or Long QT syndrome

• A seizure suddenly and without warning, especially during exercise or in response to loud sounds like doorbells, alarm clocks, or ringing phones

2: Learn to Recognize Sudden Cardiac Arrest 

If you see someone collapse, assume he has experienced sudden cardiac arrest and respond quickly. This victim will be unresponsive, gasping, or not breathing normally, and may have some jerking (Seizure like activity). Send for help and start CPR. You cannot hurt him. 

3: Learn Hands-Only CPR 

Effective CPR saves lives by circulating blood to the brain and other vital organs until rescue teams arrive. It is one of the most essential life skills you can learn – and it’s easier than ever.

• Call 911 (or ask bystanders to call 911 and get an AED)

• Push hard and fast in the center of the chest. Kneel at the victim’s side, place your hands on the lower half of the breastbone, one on top of the other, elbows straight and locked. Push down 2 inches, then up 2 inches, at a rate of 100 times/minute, to the beat of the song “Stayin’ Alive.”

• If an Automated External Defibrillator (AED) is available, open it and follow the voice prompts. It will lead you step-by-step through the process and will never shock a victim that does not need a shock.

By signing this sudden cardiac arrest form, I permit to transfer this sudden cardiac arrest form to the other sports that my child may play. I am aware of the dangers of sudden cardiac arrest, and this signed sudden cardiac arrest form will represent myself and my child during the 2022-2023 school year. This form will be stored with the athletic physical form and other accompanying forms required by the School System. 

I HAVE READ THIS FORM, AND I UNDERSTAND THE FACTS PRESENTED IN IT.

Acknowledged*