H. E. Winkler

Athletics

School Year: 2019-2020

Important Information

• This year all paperwork, except the physical, will be done

online at https://www.cabarruscountyathletics.com/haroldewinklerms

• Your physical is good for 395 days from the date of exam

• You must turn in your physical to an Athletic Forms box

o They are located in the main office or beside the boy’s

locker room door

• All paperwork must be filled out online and the physical

turned in BEFORE try-outs or open gyms/skill

developments

o Do not wait until the day of try-outs!

• If you have any questions, please see your coach or Miss

Leslie the athletic trainer

Name: _________________________

Grade: ____________

To: Parents/Guardians of prospective student-athletes

From: HWMS Athletics Department

Re: Athletic participation forms

The athletics department of Harold E. Winkler Middle School is excited that your child has

displayed interest in participating in athletics. Becoming a part of an athletic team provides

opportunities for the student-athlete to grow in areas such as physical fitness, sportsmanship,

and teamwork. Being part of an athletic team requires hard work and dedication from the athlete

and you.

Continuing during the 2019-2020 school year, all athletics paperwork will be done online,

except for the physical exam. All forms must be fully and properly completed online and a

physical turned in before a student-athlete can try out for a team or participate in skill

development. Should you have any questions or concerns about the information on these forms,

feel free to contact your child’s prospective coach or the Athletic Director at the school.

1. Website – https://www.cabarruscountyathletics.com/haroldewinklerms Please be

sure to fill out all the forms/pages completely before try-outs or skill development

days. You must get to the last page where you check everything and click Complete

Registration in order for it to submit. Do NOT wait until the last minute!

2. Physical Form (Sport Pre-participation Examination Form) – This form must be

completed by you (front side with history questions) and a physician (back side with

exam). Please explain any YES answers in the blanks provided on the front. There must

be a physician’s signature, date, and office stamp for the form to be valid. This form

will need to be turned into an Athletic Forms box located in the front office or beside

the boy’s locker room door. **The physical will be valid for 395 days from exam.

3. Accident Insurance - If you need to purchase Student Accident Insurance please do so

online at www.studentinsurance-kk.com. There are different coverages, so please

read everything carefully before selecting a plan. You do not need to turn in proof of

insurance to Winkler Athletics.

Please do not turn in an incomplete physical. Wait until you have everything filled out

completely and correctly before turning the physical in. The physical exam form may be turned

into the Athletic Forms box in the Main Office or the Athletic Forms box beside the boys’ locker

room.

Again, thank you for your and your child’s interest in being part of the Harold E. Winkler

Middle School Athletic Program. We look forward to a great season!

Sincerely,

The Athletics Department at H. E. Winkler Middle School

You only need

to register

ONCE per

school year!

Step 1: Go to https://www.cabarruscountyathletics.com

Step 2: Click Create an Account at the top of the page.

Step 3: Fill in the required fields

Step 4: Click Sign up for your Sport Ngin Account. An activation email will be sent to the email address used to create the Sport Ngin account. If you do not see the email within a couple of minutes, be sure to check your Spam/Junk folder.

Open the activation email and click on the activation link. This will bring you back to the website where you can successfully log in to your NGIN account.

How to Create an Account on Cabarrus County Athletics

Passwords must be at least 8 characters in length and must contain at least oneuppercase letter, one lowercase letter, and one number or symbol.

Need help registering? email: support@nasathletics.com

How to Register Your Student on Cabarrus County Athletics

When you are your school’s registration, scroll down to the bottom of the page to login.

You can create your account from this screen by clicking on SIGN UP.

If you already have an account you will login with your username and password.

Once you are logged in click new player from the dashboard. Then press CONTINUE

Fill out all the fields and questions in the registration. Click CONTINUE to go to the next page in the registration.

Once all the pages have been completed you will have the option to register another person or complete registration.

You will receive a confirmation email in your inbox after your registration has been submitted.

Once all the pages have been completed you will see the review button at the bottom of the page. When you click the review button you will have a chance to review your entries and make corrections.

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NORTH CAROLINA HIGH SCHOOL ATHLETIC ASSOCIATION SPORT PREPARTICIPATION EXAMINATION FORM

Student Athlete’s Name: _______________________________________ Age: ________ Sex: ____________

This is a screening examination for participation in sports. This does not substitute for a comprehensive examination with your child’s regular physician where important preventive health information can be covered.

Student-Athlete’s Directions: Please review all questions with your parent or legal custodian and answer them to the best of your knowledge. Parent/Legal Custodian Directions: Please assure that all questions are answered to the best of your knowledge. If you do not understand or are unsure about the answer to a question please ask your doctor. Not disclosing accurate information may put your child at risk during sports activity. Physician’s Directions: We recommend carefully reviewing these questions and clarifying any “Yes” or “Unsure” answers.

Explain “Yes” or “Unsure” answers in the space provided below or on an attached separate sheet if needed. Yes No Unsure 1. Does the student-athlete have any chronic medical illnesses [diabetes, asthma (exercise asthma), kidney problems,

etc.]? List:q q q

2. Is the student-athlete presently taking any medications or pills? q q q 3. Does the student-athlete have any allergies (medicine, bees or other stinging insects, latex)? q q q 4. Does the student-athlete have the sickle cell trait? q q q 5. Has the student-athlete ever had a head injury, been knocked out, or had a concussion? q q q 6. Has the student-athlete ever had a heat injury (heat stroke) or severe muscle cramps with activities? q q q 7. Has the student-athlete ever passed out or nearly passed out DURING exercise, emotion or startle? q q q 8. Has the student-athlete ever fainted or passed out AFTER exercise? q q q 9. Has the student-athlete had extreme fatigue (been really tired) with exercise (different from other children)? q q q 10. Has the student-athlete ever had trouble breathing during exercise, or a cough with exercise? q q q 11. Has the student-athlete ever been diagnosed with exercise-induced asthma? q q q 12. Has a doctor ever told the student-athlete that they have high blood pressure? q q q 13. Has a doctor ever told the student-athlete that they have a heart infection? q q q 14. Has a doctor ever ordered an EKG or other test for the student-athlete’s heart, or has the athlete ever been told they

have a heart murmur?q q q

15. Has the student-athlete ever had discomfort, pain, or pressure in his chest during or after exercise or complained oftheir heart “racing” or “skipping beats”?

q q q

16. Has the student-athlete ever had a seizure or been diagnosed with an unexplained seizure problem? q q q 17. Has the student-athlete ever had a stinger, burner or pinched nerve? q q q 18. Has the student-athlete ever had any problems with their eyes or vision? q q q 19. Place a check beside each body part that the student-athlete has ever sprained/strained, dislocated, fractured,

broken had repeated swelling in or had any other type of injury to any bones or joints?q Headq Forearm

q Shoulderq Shin/calf

q Thighq Back

q Neckq Wrist

q Elbowq Ankle

q Kneeq Hand

q Chestq Foot

q HipOther: __________

20. Has the student-athlete ever had an eating disorder, or are there concerns about his/her eating habits or weight? q q q 21. Has the student-athlete ever been hospitalized or had surgery? q q q 22. Has the student-athlete had a medical problem or injury since their last evaluation? q q q 23. (Place a check beside each statement that applies to the student-athlete, elaborate in the space provided below).

q 1. Has the student-athlete had little interest or pleasure in doing things?q 2. Has the student-athlete been feeling down, depressed, or hopeless for more than 2 weeks in a row?q 3. Has the student-athlete been feeling bad about himself/herself that they are a failure, or let their family down?q 4. Has the student-athlete had thoughts that he/she would be better off dead or hurting themselves?

FAMILY HISTORY 24. Has any family member had a sudden, unexpected death before age 50 (including from sudden infant death

syndrome [SIDS], car accident, drowning)?q q q

25. Has any family member had unexplained heart attacks, fainting or seizures? q q q 26. Does the athlete have a father, mother or brother with sickle cell disease? q q q

Explain “yes” or “unsure” answers here: ___________________________________________________________________________________

_________________________________________________________________________________________________________________________

By signing below, I agree that I have reviewed and answered each question above. Every question is answered completely and is correct to the best of my knowledge. Furthermore, as parent or legal custodian, I give consent for this examination and give permission for my child to participate in sports. Signature of parent/legal custodian: ______________________________ Date: ____________ Phone #: ____________________

Signature of Athlete: __________________________________________ Date: ____________ Page 1 of 2 (Rev. 3/2019) Approved for 2019-20 School Year

Student-Athlete’s Name: ____________________________________________Age: _____ Date of Birth: _____________________

Height: ___________ Weight: _______________ BP ( % ile) / ( % ile) Pulse: _______

Vision: R 20/ L 20/ Corrected: Y N

Physical Examination (Below Must be Completed by Licensed Physician, Nurse Practitioner or Physician Assistant)

These are required elements for all examinations NORMAL ABNORMAL ABNORMAL FINDINGS

PULSES

HEART

LUNGS

SKIN

NECK/BACK

SHOULDER

KNEE

ANKLE/FOOT

Other Orthopedic

Problems

Optional Examination Elements – Should be done if history indicates HEENT

ABDOMINAL

GENITALIA (MALES)

HERNIA (MALES)

Clearance: q A. Cleared q B. Cleared after completing evaluation/rehabilitation for: ________________________________________________________________________

q *** C. Medical Waiver Form must be attached (for the condition of: ________________________________________________________________)

q D. Not cleared for: q Collision q Contactq Non-contact Strenuous Moderately strenuous Non-strenuous

Due to: ______________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

______________________________________________________________________________________________________________________________

Additional Recommendations/Rehab Instructions: _______________________________________________________________ ___________________________________________________________________________________________________________ ___________________________________________________________________________________________________________

Name of Physician/Extender: ________________________________________________ (Please print) Signature of Physician/Extender: _____________________________________________ MD DO PA NP (Please circle) (Both signature and circle of designated degree required)

Date of Examination: _______________________________ Address: ____________________________________________ ____________________________________________________ Phone: ____________________________________

(*** The following are considered disqualifying until appropriate medical and parental releases are obtained: post-operative clearance, acute infections, obvious growth retardation, uncontrolled diabetes, severe visual or auditory impairment, pulmonary insufficiency, organic heart disease or Stage 2 hypertension, enlarged liver or spleen, a chronic musculoskeletal condition that limits ability for safe exercise/sport (i.e. Klippel-Feil anomaly, Sprengel’s deformity), history of uncontrolled seizures, absence of/ or one kidney, eye, testicle or ovary, etc.)

This form is approved by the North Carolina High School Athletic Association Sports Medicine Advisory Committee and the NCHSAA Board of Directors.

Page 2 of 2

Physician Office Stamp

(Rev. 3/2019) Approved for 2019-20 School Year