DIOCESE OF CLEVELAND CYO – ATHLETIC PREPARTICIPATION FORM
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  • DIOCESE OF CLEVELAND CYO – ATHLETIC PREPARTICIPATION FORM

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  • First Parent/Guardian

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  • PERMISSION, RELEASE, AND AUTHORIZATION TO SEEK MEDICAL TREATMENT (MINORS)

  • I, the parent or lawful guardian _________________ (the “child”), give permission for my child to of participate in Diocese of Cleveland CYO athletic and sports programs as described further in the Activity Information section below(“CYO ”) sponsored by _______________ Member Parish or School

  • In exchange for and in consideration of the opportunity for my child to participate in CYO, I agree to the following: 1. I understand what is involved CYO and acknowledge that I have had the opportunity to ask questions regarding the scope and nature of CYO. 2. I recognize the possibility and risk of injury associated with my child’s participation in CYO and that such injury can include, but is not limited to, pain, suffering, serious bodily injury, psychological injury, temporary or permanent disability, temporary or permanent paralysis, illness, disfigurement, further injury by medical treatment, and/or death. I understand that such injuries can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child’s own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure. 3. I recognize the possibility and risk of exposure or infection of COVID-19 or other communicable diseases associated with my child’s participation in CYO and that such exposure or infection may result in my or my child’s or other family members’ exposure to or infection of COVID-19 or other communicable diseases, among other risks, and that such exposure or infection may result in personal injury, illness, permanent disability, death or other damages or expenses. I understand that such exposure or infection can occur for any number of reasons which are both foreseeable and unforeseeable and which include, but are not limited to, my child’s own actions or inaction, the actions or inaction of others (whether negligent, intentional, or otherwise), and equipment failure. 4. I further understand that my child’s participation in CYO is purely voluntary and is a privilege and not a right, and that my child, and I on behalf of my child, agree to my Child’s participation in CYO in spite of the risks. I and my spouse assume, for ourselves and on behalf of our minor child (ren), all risks in connection with my child’s participation in CYO and accept sole responsibility for any injury to such persons including, but not limited to, personal injury, disability, death, illness, damage, loss, claim, liability, or expense, of any kind, that such person(s) may experience or incur in connection with the use of facilities or participation in CYO. 5. I agree to instruct my child to cooperate with those persons in charge of CYO including complying with all rules and guidelines set forth by CYO Diocese of Cleveland and/or any sponsoring parish or organization. I understand and agree that, in the event my child does not cooperate with the person(s) in charge of the activity, or comply with applicable rules and guidelines as determined at the sole discretion of the person(s) in charge of the activity, I agree to cooperate in picking up my child to remove them from the activity. 6. I and my minor child agree to follow and comply with all safety protocols and procedures related to COVID- 19 or other communicable diseases as described in CYO Diocese of Cleveland’s rules and guidelines, as the same may be amended from time to time, or as may be adopted by any sponsoring parish or organization.. 7. To the fullest extent allowed by law, I, on behalf of myself, my spouse, my minor child, as well as our respective heirs and assigns, executors, all other legal representatives and any others claiming through us or on behalf of us, hereby agree to release, discharge, hold harmless and indemnify Catholic Charities Corporation, dba Catholic Charities Diocese of Cleveland (“CCDOC”), sponsoring Parishes and Schools, the Catholic Diocese of Cleveland, the Bishop or Administrator of the Catholic Diocese of Cleveland, as well as their respective clergy, officers, employees, agents, representatives, attorneys, sponsors, and volunteers (“Released Parties”) forever from and against any and all claims, lawsuits, damages, judgments, expenses including attorney’s fees, liabilities (of any nature or extent), demands, damages, cause of action of any nature and kind, known or unknown, which in any way arise out of or relate to my child’s participation in CYO (including without limitation any injury, loss, or damage to my child’s person or property), whether foreseen or unforeseen, regardless of the cause (including, but not limited to, the negligence of any person) (the “Claims”). 8. I understand that it is my responsibility to carry appropriate medical insurance for my child and that such is not the responsibility of any other person or party, including, without limitation, CCDOC, the Parish, School or the Diocese of Cleveland. 9. In the event reasonable attempts to contact me at the number listed below have been unsuccessful, I hereby authorize any of the staff, employees, volunteers, agents and/or representatives of CYO and the sponsoring Parish and Schools to provide for, seek, and authorize medical treatment for my child in the case of illness or accident from the closest and most appropriate licensed medical practitioner or hospital available. I understand that this authorization does not cover major surgery unless the medical opinions of two licensed physicians/dentists concurring in the necessity for such surgery are obtained for the performance of such surgery.

  • 10. I {checkOne} consent and grant permission or do not consent and grant permission for CCDOC, sponsoring Parishes and Schools, the Catholic Diocese of Cleveland, the Bishop or Administrator of the Catholic Diocese of Cleveland and/or its employees, volunteers, or agents (“Permitted Parties”) to record (in writing or otherwise), photograph, audio record, and video record my minor child’s name, image, likeness, spoken words, in any form (the “Recordings”), and to display, release, exhibit, publish, or distribute the Recordings, or any part thereof, for the purpose of and in connection with any material that may be created by or on behalf of the Permitted Parties including, without limitation, through the Permitted Parties’ bulletin boards, social media, website, print and electronic media, marketing publications, public relations and communications materials and/or presentations, and any other uses as may not be contemplated herein, without further notice or compensation, and I agree that the Recordings shall constitute the sole property of the Permitted Parties. I further agree to release CCDOC, sponsoring Parish and Schools, the Catholic Diocese of Cleveland, and the Bishop of the Diocese of Cleveland, and their respective officers, directors, agents, employees and/or attorneys from and against any and all liability, loss, damage, costs, claims, and/or causes of action arising out of or related to the above items to which I have consented. I further understand that the Permitted Parties and its respective officers, directors, agents and/or employees have no control over use of photographs, videotapes, audiotapes, or other records made by others and/or outside the scope of this consent and release. 11. To the fullest extent allowed by applicable law, the Agreement shall be binding upon and inure to the benefit of the parties and their respective heirs, administrators, personal representatives, executors, successors and assigns. I, on my behalf and on behalf of my minor child, have the authority to release the Claims and have not assigned or transferred any Claims to any other party. This Agreement constitutes the entire agreement between the parties and supersedes any and all prior oral or written agreements or understandings between the parties concerning the subject matters of this Agreement. This Agreement may not be altered, amended or modified, except by a written document signed by both parties. The Released Parties, to the extent they are not parties to this agreement, are intended to be third party beneficiaries. 12. This acknowledgement and release is intended to be as broad and inclusive as permitted by the law of the Stateof Ohio, and if any portion hereof is declared invalid, it is agreed that the balance shall, notwithstanding, continue in full legalforce and effect. This acknowledgement and release shall be construed in accordance with the laws of the State of Ohio,except for the choice of law provisions thereof.

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  • Sudden Cardiac Arrest and Lindsay’s Law

    • What is Lindsay’s Law? Lindsay’s Law is about Sudden Cardiac Arrest (SCA) in youth athletes. It covers all athletes 19 years or younger who practice for or compete in athletic activities. Activities may be organized by a school or youth sports organization. Which youth athletic activities are included in Lindsay’s law?
    • Any athletic contest or competition sponsored by or associated with a school
    • All interscholastic athletics, including all practices, interschool practices and scrimmages
    • All youth sports organizations
    • All cheerleading and club sports, including noncompetitive cheerleading

    Athletics at all schools in Ohio (public and non-public)

    What is SCA? SCA is when the heart stops beating suddenly and unexpectedly. This cuts off blood flow to the brain and other vital organs. People with SCA will die if not treated immediately. SCA can be caused by 1) a structural issue with the heart, OR 2) an heart electrical problem which controls the heartbeat, OR 3) a situation such as a person who is hit in the chest or a gets a heart infection.

    What is a warning sign for SCA? If a family member died suddenly before age 50, or a family member has cardiomyopathy, long QT syndrome, Marfan syndrome or other rhythm problems of the heart.

    • What symptoms are a warning sign of SCA? A young athlete may have these things with exercise:
    • Chest pain/discomfort
    • Unexplained fainting/near fainting or dizziness
    • Unexplained tiredness, shortness of breath or difficulty breathing
    • Unusually fast or racing heart beats

    What happens if an athlete experiences syncope or fainting before, during or after a practice, scrimmage, or competitive play? The coach MUST remove the youth athlete from activity immediately. The youth athlete MUST be seen and cleared by a health care provider before returning to activity. This written clearance must be shared with a school or sports official.

    What happens if an athlete experiences any other warning signs of SCA? The youth athlete should be seen by a health care professional.

    Who can evaluate and clear youth athletes? A physician (MD or DO), a certified nurse practitioner, a clinical nurse specialist, certified nurse midwife. For school athletes, a physician assistant or licensed athletic trainer may also clear a student. That person may refer the youth to another health care provider for further evaluation.

    What is needed for the youth athlete to return to the activity? There must be clearance from the health care provider in writing. This must be given to the coach and school or sports official before return to activity.

    All youth athletes and their parents/guardians must review information about Sudden Cardiac Arrest, then sign and return this form.

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