Pioneer High School Athletic Checklist

_______________________________________________________________________________________________ Stefani Garino, Principal All Students Can Learn...All Students Can Succeed! Joe Berticevich, Athletic Director ______ •Fill out the SJUSD form. The doctor must sign the form. ______ •Fill out the front of the Pre-Participation form. The doctor needs to complete the back of the form during the physical. ______ •Read and sign Student-Athlete Contract and Concussion Form. ______ •Turn completed forms into your Head Coach. Official Start Dates: Fall Sports – August 10, 2012 B/G Cross Country, Football, G Tennis, G Volleyball, B/G Water polo Winter Sports – October 29, 2012 B/G Basketball, B/G Soccer, B/G Wrestling Spring Sports – January 28, 2013 B/G Badminton, Baseball, B/G Golf, G Lacrosse, Softball, B/G Swimming & Diving, B Tennis, B/G Track & Field, B Volleyball

PIONEER HIGH SCHOOL ATHLETICS

1290 Blossom Hill Road San Jose, CA 95118 Phone: 408-535-6310 Fax: 408-535-2357 revised:10/26/11

INTERSCHOLASTIC STUDENT-ATHLETE POLICIES AND AGREEMENT

The following general policies shall govern each student-athlete participating in any phase of the Pioneer High School Athletic Program. As a member of the Pioneer Athletic Program, I____________________________________ agree to abide by the following policies: I. Adherence to the San Jose Unified School District Student Handbook The student will abide by all the rules and regulations of the San Jose Unified School District Student Handbook. Copies of the handbook are distributed to each student annually, and are available in the school office. Each athlete is advised to familiarize him/herself with those rules and regulations. II. Eligibility The student must meet all of the age, enrollment, attendance, and scholastic requirements established by the Blossom Valley Athletic League, and the Central Coast Section of the CIF. Students must maintain a 2.0 GPA to participate in interscholastic athletics. Grades are checked after every six week grading period, and eligibility will change 5 working days after the end of a grading period. III. Forms and Releases Before a student may participate in any sport including conditioning and practices, he/she must have the following information to the Athletic Director. A. The San Jose Unified School District health questionnaire, and physical examination card, with parent and physicians signatures. B. Proof of Insurance with the insurance company listed on the card. Insurance is available for purchase through the school for families that do not have family health insurance. C. A copy of the Emergency Information card to be held by the coaches while in season. D. Interscholastic Student-Athlete Policy and Agreement to Athletic Director. IV. Medical Release to Again Participate If an athlete is seriously injured and is seen by a doctor, he/she must provide a doctor’s release before he/she can return to practice or play in an athletic contest. The release may be written, or it may be oral given directly to the Coach or Athletic Director. V. Concussion Protocol

A student who is suspected of sustaining a concussion/head injury in a practice/game shall removed from competition at that time for the remainder of the day. The student who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in education and management of concussion and receives written clearance to return to play from that health care provider.

VI. Attendance A student is expected to attend all classes on his/her schedule on the day of a contest and the next school day, he/she must be present at least the afternoon of the contest, unless the student has been excluded from school attendance for such reasons as doctor’s appointment, field trip, college visitation, or such reasons other than illness. The purpose of this clause is to keep a student from participating when he/she is ill. VII. Attendance at Practices and Team meetings Team members are expected to be present at all practices, team meetings, contests, and special occasions unless excused by the head coach. VIII. Care of School Equipment The athlete is responsible for all equipment issued to him/her. Stolen or damaged equipment must be paid for by the athlete or his parents before any grade is issued. IX. Transportation to Athletic Contests All team members will travel to and from away contests by means of transportation provided or organized by the Coach and/or Athletic Director. Some teams, by their nature, will travel by bus, while some will use private transportation. Parents driving must have an up-to-date driver form on file with the Athletic Director. At no time will students drive other students to contests.

PIONEER HIGH SCHOOL ATHLETICS

1290 Blossom Hill Road San Jose, CA 95118 Phone: 408-535-6310 Fax: 408-535-2357 revised:10/26/11

X. Personal Conduct Participation on an athletic team at Pioneer High School is a privilege and the participants must earn the right to represent Pioneer High School by conducting themselves is such a way that the image of Pioneer High School would not be tarnished in any manner. Any participant whose conduct is judged to reflect a discredit upon himself/herself, the team, or Pioneer High School, whether or not such activity takes place during or outside school hours and sessions of the sport season, will be subject to disciplinary action as determined by the coach, the athletic director and/or the school principal. XI. Use of Tobacco, Alcohol, and Drugs Smoking, the use of chewing tobacco and smokeless tobacco, drinking alcoholic beverages, the illegal use of drugs by any athlete is prohibited both in and out of season and during such time as school is not in session. An athlete will be disciplined by the coach and/or athletic director if an infraction has occurred. XII. Steroid Use As a condition of membership in the CIF, all schools shall adopt policies prohibiting the use and abuse of androgenic/anabolic steroids. All member schools shall have participating students and their parents, legal guardian/caregiver agree that the athlete will not use steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition (Bylaw 524). Both the participating student-athlete and the parents, legal guardian/caregiver hereby agree that the student shall 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 that that under CIF Bylaw 200.D., there could be penalties for false or fraudulent information. We also understand that the San Jose Unified School District policy regarding the use of illegal drugs will be enforced for any violations of these rules. XIII. Quitting a Team The normal rule for athletes quitting a team is that they make themselves ineligible for any sport during that season which has already begun. An athlete that goes out for a sport, but is “cut” would be eligible to try out and participate in another sport during that season. XIV. Team and Individual Discipline Each coach will have discipline rules for minor infractions, such as inattention to directions, horseplay, tardiness to practice, etc. XV. Suspension from a Team or Squad Temporary suspensions will be made by the coach of the sport, athletic director, or school administrator. The athletic director and/or administration will confer with the coach before action is taken. Causes for temporary suspension may include, but not limited to: grades, personal misconduct, unexcused absences from meetings or practices, violation of athletic policies, or unsportsmanlike conduct. XVI. Removal from a Team Removal from a team will be made by the coach, athletic director, or school administrator. The athletic director and/or administrator will confer with the coach before any action is taken. Causes for removal from a team may include, but not limited to: use of alcohol or tobacco, illegal possession of drugs, continued violations of the District Behavior Handbook, repeated violations of school athletic or team policies, personal misconduct that involves police or court action, verbal or physical attack upon an opponent, official, teacher, fan, coach, or any other person, continued acts of unsportsmanlike conduct. We have read, and agree to the listed policies- Signature of Athlete ___________________________________________ Date __________________ Signature of Parent/Guardian ___________________________________ Date __________________

Pioneer High School Concussion Information Sheet

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 5/20/2010

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head, or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are potentially serious and may result in complications including prolonged brain damage and death if not recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t see a concussion and most sports 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. If your child reports any symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right away. Symptoms may include one or more of the following:

• Headaches • “Pressure in head” • Nausea or vomiting • Neck pain • Balance problems or dizziness • Blurred, double, or fuzzy vision • Sensitivity to light or noise • Feeling sluggish or slowed down • Feeling foggy or groggy • Drowsiness • Change in sleep patterns

• Amnesia • “Don’t feel right” • Fatigue or low energy • Sadness • Nervousness or anxiety • Irritability • More emotional • Confusion • Concentration or memory problems

(forgetting game plays) • Repeating the same question/comment

Signs observed by teammates, parents and coaches include:

• Appears dazed • Vacant facial expression • Confused about assignment • Forgets plays • Is unsure of game, score, or opponent • Moves clumsily or displays incoordination • Answers questions slowly • Slurred speech • Shows behavior or personality changes • Can’t recall events prior to hit • Can’t recall events after hit • Seizures or convulsions • Any change in typical behavior or personality • Loses consciousness

Pioneer High School Concussion Information Sheet

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 5/20/2010

What can happen if my child keeps on playing with a concussion or returns to soon?

Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs, particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal consequences. It is well known that adolescent or teenage athlete will often under report symptoms of injuries. And concussions are no different. As a result, education of administrators, coaches, parents and students is the key for student-athlete’s safety.

If you think your child has suffered a concussion

Any athlete even suspected of suffering a concussion should be removed from the game or practice 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 medical clearance. Close observation of the athlete should continue for several hours. The new CIF Bylaw 313 now requires implementation of long and well-established return to play concussion guidelines that have been recommended for several years:  CIF Bylaw 313. CONCUSSION PROTOCOL

A student-athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be removed from competition at that time for the remainder of the day. A student-athlete who has been removed from play may not return to play until the athlete is evaluated by a licensed health care provider trained in education and management of concussion and receives written clearance to return to play from that health care provider.

(Approved May 2010 Federated Council) Q: What is meant by “licensed health care provider?” A: The “scope of practice” for licensed health care providers and medical professionals is defined by California state statutes. This scope of practice will limit the evaluation to a medical doctor (MD) or doctor of osteopathy (DO).

You should also inform your child’s coach if you think that your child may have a concussion Remember its better to miss one game than miss the whole season. And when in doubt, the athlete sits out.

For current and up-to-date information on concussions you can go to:

http://www.cdc.gov/ConcussionInYouthSports/ _____________________________ _____________________________ _____________ Student-athlete Name Printed Student-athlete Signature Date _____________________________ ______________________________ _____________ Parent or Legal Guardian Printed Parent or Legal Guardian Signature Date