2023-2024 ATHLETIC/CO-CURRICULAR CONTRACT

Statement acknowledging receipt of education and responsibility to report signs or symptoms ofconcussion to be included as part of the “Participant and Parental Disclosure and Consent Document”.

I,

, the student/athlete hereby acknowledge having received education about the signs, symptoms, and risks of sport related concussion. I also acknowledge my responsibility to report to my coaches, parent(s)/guardian(s) any signs or symptoms of a concussion. I certify that I have read, understand, and agree to abide by all the information contained in this sheet.I further certify that if I have not understood any information contained in this document, I havesought and received an explanation of the information prior to signing this statement.

I,

, the parent/guardian of the student athlete named above,hereby acknowledge having received education about the signs, symptoms, and risks of sport relatedconcussion. I certify that I have read, understand, and agree to abide by all of the informationcontained in this sheet. I further certify that if I have not understood any information contained in thisdocument, I have sought and received an explanation of the information prior to signing this statement.

Link for information

I, 

, the student/athlete have read the Sudden Cardiac Arrest Information sheet. I understand that I should stop activity/exercise immediately if I have any warning signs of sudden cardiac arrest andreport the symptoms to my coaches and my parents/guardians.

I, 

, the parent/guardian of the student athlete named above have read the Sudden Cardiac Arrest information sheet. I understand that my child should stop activity/exercise immediately if they have any warning signs of sudden cardiac arrest. I understand it is recommended if my child has any warning signs of sudden cardiac arrest while exercising, they have a medical examination before exercising or returning to participation in their sport. I understand that I or my child should report a family history of heart problems or warning signs of sudden cardiac arrest to the healthcare provider doing the medical examination.

Requesting the parent and student signature on this page is done to help ensure students/parents awareness of the co-curricular code, however failure to have a signature page on file does not exempt a student from this code. A signature also states you have viewed and understand the video. Link

I certify that I have read; understand, and agree to abide by all of the information contained in the WIAA Athletic Eligibility Information Bulletin. I further certify that if I have not understood any information contained in this document, I have sought and received an explanation of the information prior to signing this statement.

Parent Code of Conduct Link. Please read before acknowledging.

By checking the box below, you confirm that you have read the Parent Code of Conduct and agree to it.

The following signatures are required prior to practice or competition for any Barneveldco-curricular participants

The administration retains the right to deal with any action not covered by this handbook. Administration may vary from the discipline offense procedures whenever the act deems necessary, but will always remain in accordance with WIAA guidelines.

In the event that either parent or emergency contact person cannot be contacted by telephone, / authorize the Barneveld School District to use discretion and seek medical attention/transportation.