Updated: August 24, 2020

1

TABLE OF CONTENTS Page

Letter from Superintendent Donna Miller

4

Board Commitment 6

Student Commitment and Obligations 6

Parent / Guardian Expectations 8

Communication 8

Responsibilities and Guidelines 10

Girard School District Eligibility Guidelines 12

Schedules 13

Transportation 14

Fundraising 14

Awards and Recognition – Letters and Pins 14

Required Student/Parent School-Sponsored Activities Handbook Signatures 14

Obligations Prior to Start of Season – Student-Athletes Only 15

PIAA Specific Regulations – Student-Athletes Only 16

Health, Medications and Physical Examinations, Including CIPPE Form 17

NCAA Division I or Division II Initial – Eligibility 18

Clearances/Requirements, Employment and Volunteers 19

Pre-Participation Physical Packet 20

Parental Code of Ethics Form (Parental Agreement) 31

GSD Student Code of Conduct Form 32

GSD Release and Waiver of Liability Form 33

Student / Parent School-Sponsored Activities Handbook Signature Form 34

Participation Waiver for Communicable Diseases Including COVID-19 Recommendations 35

Girard Athletic Training Medical Information Card 37

2

Purpose of Extracurricular Participation

3

Dear Parents/Guardians,

The Girard School District is pleased to welcome our students back to school and to the many interscholastic opportunities offered to youth in grades 7-12. In addition to the guidelines contained in this document, keep in mind that for this year, we will also be following the CDC guidance related to COVID-19 for athletics and the arts. We all share in the efforts to avoid disruptions in scheduled interscholastic events by following health and safety protocols.

In general, students, coaches, directors and spectators should be prepared to follow the Department of Health’s universal face covering order both inside and outside activities when unable to maintain 6’ of physical space from other individuals whom do not reside in your home. Maintaining 6’ of physical space between themselves and others, and careful handwashing will help us to avoid disruptions in interscholastic activities.

This year, our Athletic Director, Mr. Mark Amenta, has implemented health related guidance and procedures to mitigate the transmission of the coronavirus. Coaches have been trained on these processes.

Above all, no individual should enter the school or outdoor athletic fields if they have COVID-19 symptoms, which include:

• Fever or chills• Cough• Shortness of breath or difficulty breathing• Fatigue• Muscle or body aches• Headache• New loss of taste or smell• Sore throat• Congestion or runny nose• Nausea or vomiting• Diarrhea

Thank you for supporting your child’s participation in activities beyond the school day that enrich their school experiences and teach valuable life lessons.

Donna M. Miller

Mrs. Donna Miller Superintendent of Schools

GIRARD SCHOOL DISTRICT ADMINISTRATION

OFFICE 1203 Lake Street Girard, PA 16417

814-774-5666FAX 814-774-4220

GIRARD HIGH SCHOOL

1135 Lake Street Girard, PA 16417

814-774-5607FAX 814-774-4530

RICE AVENUE MIDDLE SCHOOL

1100 Rice Avenue Girard, PA 16417

814-774-5604FAX 814-774-4127

ELK VALLEY ELEMENTARY SCHOOL

2556 Maple Avenue Lake City, PA 16423

814-774-5602FAX 814-774-8885

3

PURPOSE OF EXTRACURRICULAR PARTICIPATION

It is the basic educational philosophy of the Girard School District (GSD) to prepare our

students to become productive, contributing citizens of our community and society. Our

athletic and extracurricular school-sponsored programs are an extension of this philosophy.

The programs of interscholastic events shall include all activities relating to competitive or

exhibition activities, games or events involving individual students or teams of students when

such events occur between schools within this district or outside this district, including athletic,

academic, and performing art competitions and presentations.

Practices and procedures presented in this handbook will outline the expectations related to

the interscholastic/extracurricular GSD sponsored programs including:

1. Athletics2. Marching Band3. Bell Choir4. Cheerleading5. Drama6. Academic Competitions

Extracurricular/Interscholastic Objectives

1. Provide natural outlets for students desiring to participate on athletic, academic and

performing arts teams in competition with other teams of similar abilities.

2. Provide for natural outlets for students desiring to participate in non-competitive activities

such as the theatrical arts.

2. To assist in the development of school and student morale.

3. To teach good character traits, teamwork and skill development.

4. To help develop lifetime skills.

5. To teach communication and problem solving techniques.

4

GSD EXTRACURRICULAR SCHOOL-SPONSORED ACTIVITIES

1. Cross Country: Varsity, Jr. High

2. Football: Varsity, Jr. Varsity, Jr. High

3. Golf: Varsity

4. Soccer, Boys’: Varsity, Jr. Varsity, Jr. High (Spring)

5. Soccer, Girls’: Varsity, Jr. Varsity, Jr. High (Spring)

6. Volleyball, Girls’: Varsity, Jr. Varsity, Jr. High (Spring)

7. Cheerleading: Varsity, Jr. Varsity, Jr. High

8. Basketball, Boys’: Varsity, Jr. Varsity, Freshman, 8th Grade, 7th Grade

9. Basketball, Girls’: Varsity, Jr. Varsity, 8th Grade (Fall), 7th Grade (Fall)

10. Swimming, Boys’: Varsity

11. Swimming, Girls’: Varsity

12. Wrestling: Varsity, Jr. Varsity, Jr. High

13. Baseball, Boys’: Varsity, Jr. Varsity

14. Softball, Girls’: Varsity, Jr. Varsity

15. Tennis: Varsity

16. Track & Field, Boys’: Varsity

17. Track & Field, Girls’: Varsity

18. Marching Band and Color Guard

19. Concert Band, Chorus and Bell Choir

20. Performing Arts Members

21. LEGO League

22. Technology Student Association (TSA) Competitions; Tests of Engineering Aptitude,

Mathematics, and Science

23. Skills USA (ECTS)

24. Regional National History Day

25. Governor’s STEM Competition

26. Model UN

27. Other as approved by the Superintendent of Schools and School Board

5

BOARD COMMITMENT

The Board recognizes the value of a program of interscholastic activities as an integral part of the total school experience for all district students and as a conduit for community involvement. The programs foster the growth of school loyalty within the student body as a whole and stimulates community interest.

It shall be the policy of the Board to offer opportunities for participation in interscholastic activity programs to male and female students on as equal a basis as is practicable and without discrimination, in accordance with law and regulations.

The Board directs that no student may participate in interscholastic activities who has not:

1. Met the requirements for academic eligibility.

2. Attended school regularly.

3. Been in attendance until or by 11:00 AM in order to participate for that day’sactivity/sport.

4. Returned all school equipment previously used.

5. Adhered to applicable discipline standards.

STUDENT COMMITMENT AND OBLIGATIONS

The student shall make a commitment to the program in which he/she participates, including post-season playoffs, tournaments, and exhibitions. The exception will be illness/injury in which participation is limited.

During extracurricular school-sponsored activities (including practices and competitions), the students, coaches, performing arts directors, academic advisors, officials, and parents are in the public eye and their personal conduct is subject to the scrutiny of community members, fellow students, opponents, and the media. Students must represent GSD at all times in an appropriate and respectful manner. Failure to represent the school district in accordance with the Code of Conduct may result in suspension or termination from one’s participation.

To serve as positive role models, students are required to satisfy obligations intended to maintain a level of excellence and integrity for the Girard School District. These obligations include:

1. Students should be neatly groomed and properly dressed when traveling to anycontest/event.

2. Students should always show respect for property and authority.

6

3. Students should emphasize the ideals of determination, loyalty, ethical conduct and fairness.

4. Students should attend and be on-time for scheduled practice / game / tournaments /performances. If student cannot attend, he/she must notify the coach, arts director or academicadvisor.

5. Students should leave all valuables at home or with coaches/advisors, not in the locker room.

6. Students must return all issued equipment/uniforms/costumes in good condition at the end ofactive participation. All such attire should only be worn/used only when authorized by thecoach/advisor. Students failing to return issued equipment/uniforms/costumes or pay restitutionmay jeopardize future program eligibility. It is important to note that the Girard School Districtpolicy mandates that all debts owed to the school such as fees, library fines, activity fees, lost ordamaged books, cafeteria debts, etc. must be paid.

7. Some extracurricular activities require the purchase of specific items for student participants.It is the responsibility of the student or their parent to pay for these items, even if the studentchanges their mind and quits the team or other activity. There will be no refunds.

8. A student must pursue an approved schedule, which meets the necessary academicrequirements of the district, and maintain an appropriate record of attendance.

9. A student must understand that eligibility to participate in an identified activity may besuspended or revoked for unsuccessful academic progress, repeated infractions of school rules,or poor attendance.

Off-Campus Activities

Student conduct that occurs off school property is also subject to the Code of Student Conduct if any of the following circumstances exist:

1. The conduct occurs during the time the student is traveling to and from school or travelingto and from school-sponsored activities, whether or not via school district furnishedtransportation.

2. The student is a member of an extracurricular activity and has been notified that particularoff-campus conduct could result in exclusion from such activities.

3. Student expression or conduct materially and substantially disrupts the operations of theschool, or the administration reasonably anticipates that the expression or conduct is likelyto materially and substantially disrupt the operations of the school.

4. The conduct has a direct nexus to attendance at school or a school-sponsored activity, forexample, a transaction conducted outside of school pursuant to an agreement made inschool, that would violate the Code of Student Conduct if conducted in school.

5. The conduct involves the theft or vandalism of school property.6. There is otherwise a nexus between the proximity or timing of the conduct in relation to

the student's attendance at school or school-sponsored activities.

7

PARENT/GUARDIAN EXPECTATIONS

Parents/Guardians are encouraged to support their child’s extracurricular endeavors by following these expectations:

1. Support student’s efforts toward success by following the GSD Parental Code of Ethics(see page 30).

2. Work to promote a positive environment that is conducive to the development of thestudent.

3. Become familiar with, and review the rules and regulations with the student. Understandthe attendance, academic and code of conduct eligibility and requirements to participate.

4. Encourage student to talk with his/her coach, arts director or advisor to solve anyissues, concerns or problems.

5. Communicate any concern in a timely manner, according to district contact procedure.6. Treat all coaches, directors, advisors, officials and other team members with courtesy

and respect, and insist child demonstrates the same.7. Model good sportsmanship and talk to student about demonstrating respect and

sportsmanship.8. Complete and return (before first practice) all participation paperwork to the coach,

performing arts director or advisor: Such as, but not limited to:a. Pre-Participation Physical Packet (CIPPE form) – student athletes onlyb. Sign Code of Conduct formc. Sign Release and Waiver of Liability formd. Review and sign the Parental Code of Ethics forme. Student/Parent School-Sponsored Activities Handbook Signature form

COMMUNICATION

STUDENT / COACH, DIRECTOR, ACADEMIC ADVISOR / PARENT

Communication between coaches, directors, academic advisors and parents/guardians and students ensures a positive and healthy relationship. Girard School District strongly encourages students to have an open communication with his/her coach, performing arts director or athletic advisor.

If there is a concern to discuss with a coach, performing arts director or academic advisor, the following procedures should be followed:

Step 1: Student talks to Head Coach, Performing Arts Director or Academic Advisor

If not satisfied: Step 2: Student Athletes - If the student continues to feel a problem exists, parents

contact the Athletic Director Step 2: All other students participating in extracurricular activities – If the student continues to feel a problem exists, parents contact the Building Principal

8

If still not satisfied: Step 3: Student Athletes: – Contact the Building Principal Step 3: All other students participating in extracurricular activities – Contact the Superintendent of Schools

If still not satisfied: Step 4: Student Athletes: Contact the Superintendent of Schools Step 4: All other students participating in extracurricular activities: Contact the School Board

If still not satisfied: Step 5: Student Athletes: Contact the School Board

The following items are some appropriate concerns to discuss with coaches, directors and advisors:

1. The physical and mental treatment of your child.2. Ways to help your child improve his/her skills.3. Concerns about your child’s behavior.

The following items are not appropriate to discuss with the coaches, directors and advisors:

1. Playing time or time on stage.2. Team strategy or play calling.3. Other students.

In the event that a parent or spectator does physically and/or verbally attack a coach, director, advisor, player, and/or program personnel, district personnel are directed to call 9-1-1 for Police assistance, resulting in the actor being banned from all grounds, facilities, properties and events of the Girard School District.

COMMUNICATION YOU SHOULD EXPECT FROM COACHES, PERFORMING ARTS DIRECTORS AND/OR ACADEMIC LEAGUE ADVISORS

1. Philosophy and expectations for the student and the team or group as a whole.2. Locations and times of all practices and contests/performances.3. Requirements: i.e., fees, special equipment, off-season conditioning, fundraising, etc.4. Procedure should the student be injured during participation.5. Actions that could lead to discipline which may result in the denial of the student’sparticipation.

9

RESPONSIBILITIES AND GUIDELINES

School Administration will be the sole arbiters of interpretation, violation, and penalization of every aspect of the Code of Conduct. Consequences for violation will be levied according to the degree of the offense and may include removal from the event, barring from school grounds, facilities, properties, and events, and/or involvement of legal authorities.

Participants/Students

1. Live up to the standards of ethics established by the school administration and staff.

2. Accept and understand the seriousness of responsibility, and the privilege of representingyour school and your community.

3. Demonstrate respect for your coach, performing arts director or academic advisor at alltimes.

4. Learn the rules of the game/program thoroughly.

5. Treat opponents the way you would like to be treated, as a guest or friend.

6. Respect the integrity and judgment of contest officials. Treating them with respect, even ifyou disagree with their judgment, will only make a positive impression of you and your team inthe eyes of the officials and all people at the event.

Spectators

1. Remember that extracurricular activities are a learning experience for students and thatmistakes are sometimes made. Praise students in their attempt to improve themselves.

2. Recognize and show appreciation for an outstanding performance from all schools.

3. Respect the integrity and judgment of officials. Understand that they are doing their best tohelp promote the student, and admire their willingness to participate in full view of the public.

4. Refrain from the use of any controlled substances (alcohol, drugs, tobacco/nicotine, e-cigarettes, etc.) before, and during events and afterwards on or near the site of the event (i.e.tailgating).

5. Be a positive role model through your own actions and by censuring those around youwhose behavior is unbecoming.

10

Coaches, Performing Arts Directors and Academic Advisors

1. Respect the integrity and personality of the individual student. Refrain from makingdemeaning remarks to a student in public or private.

2. Exemplify the highest moral character, behavior and leadership, adhering to strong ethicaland integrity standards all year, including both active participation seasons and off- season. Set agood example for players, students and spectators to follow by refraining from arguments infront of them; no gestures which indicate disrespect to officials, opposing coaches, participantsor spectators; throwing of any object; refrain from using profanity or obscene gestures.

3. Respect the integrity and judgment of officials. Shake hands with the officials and theopposing coaches before and after the contest in full view of the public. The officials are doingtheir best. Treating them with respect, even if you disagree with their judgment, will only makea positive impression of you and your team in the eyes of all people at the event.

4. All coaches, academic advisors, and performing arts directors are responsible for the health,safety, supervision and well-being of students under his/her supervision until end of practice,game, competition or scheduled event until the student is released into the care of his/herparent/guardian.

Unacceptable Behavior from the public, coaches, directors, advisors, officials, students, employees, and volunteers:

1. Yelling or waving arms or objects during opponent's play.

2. Disrespectful or derogatory cheers, chants, songs or gestures.

3. Criticizing officials in any way; displays of extreme temper with an official's call.

4. Cheers that antagonize opponents.

5. Refusing to shake hands or give recognition for good performances.

6. Blaming loss of contest on officials, coaches or participants.

7. Laughing or name-calling to distract an opponent.

8. Use of profanity, displays of anger or hostile behavior.

9. Wearing extreme or unusual clothing or excessive face or body painting, which detracts fromthe event.

11

GIRARD SCHOOL DISTRICT ELIGIBILITY GUIDELINES

Students are expected to adhere to the Code of Conduct guidelines established by his/her extracurricular activity and Girard School District.

To be eligible to participate in interscholastic activities for the Girard School District, the students must be in compliance with the rules and regulations of Girard School District and PIAA for student athletes. All school rules and regulations are in effect for individuals while participating in an identified activity.

GSD ELIGIBILITY – ATTENDANCE

In order to participate in any school-sponsored activity that day, a student must either be in attendance until 11:00am, or arrive to school by 11:00am.

This will carry over for any events on a weekend, if a student misses the previous school day (ex: must attend half-day on Friday to participate in event on Saturday).

Any exceptions must be pre-approved by the school office (ex: funeral, college visit).

The head coach or director/advisor will be notified prior to an event that a student will be unable to participate for violating this attendance policy.

GSD ELIGIBILITY – ACADEMICS

Academic eligibility for school-sponsored activities is based on the premise that academic performance is the keystone of the curriculum and the standard against which participation is measured. The appropriate building level administrator will monitor the weekly eligibility of students.

1. Assistant principal will run an eligibility report Friday at 1pm. Students will be ineligibleif they have more than one D or F.

2. Students/coaches/performing arts directors and academic advisors will be notified Fridayvia email, or phone call in some cases, if there are ineligible students on their roster.

3. Students will be ineligible Sunday through Saturday.4. If students turn in missing assignments, teacher has right/opportunity to speak to

assistant principal and determine together whether the student should become eligible.5. Reassessment: If a student has requested reassessment for a summative assignment,

then the reassessment grade could be used to establish the current class average fordetermining eligibility. This will depend upon individual circumstances, and coordinationfrom the teacher and the assistant principal.

6. First time/week of ineligibility, student may train and travel with team, but may notparticipate in extracurricular activity. The coach, performing arts director, or academicadvisor has the right to send student to study hall or home to do school work, ratherthan having him/her at practice/training.

12

7. If a second or more week of ineligibility occurs, then the student may not train or traveluntil grades are passing.

8. In the case of excused legal absences, if missing work causes student to be ineligible,then the student will have the opportunity to complete/turn in the missing assignments,and then have that reflected in the class average. Extended time for completing thework is appropriate, as determined cooperatively by the teacher and assistant principal.

STUDENT CONDUCT

Students must adhere to the GSD Student Code of Conduct to be eligible to participate.

Violations & Suspensions:

1. For violations involving in school suspension (ISS), the student will be suspended fromattending any competition or performance or practices throughout the suspensionperiod for the entire day, including the evening, for the entire length of their suspension.If there is no competition or performance during the time of his/her suspension, thenthey will miss the next scheduled competition or performance. This is at the discretionof the administration.

2. For violations involving out of school suspension (OSS), the student will be consideredineligible to participate or attend a school function for the entire day, including theevening for the entire length of their suspension. If there is no practice or competitionor performance on the days of the OSS suspension, the student will miss the nextpractice and the next scheduled event. This is at the discretion of the administration.

3. For severe and/or several violations involving ISS or OSS, the student may lose theprivilege to participate in any Girard School District extracurricular programs for thebalance of his/her high school career. This is at the discretion of the administration.

4. If additional information is needed, students and parents should contact the schoolprincipal.

SCHEDULES

Coaches, performing arts directors and advisors print and distribute schedules prior to the start of season.

The Athletic Director will do all scheduling of interscholastic athletic competitions with information gathered from the Head Coach.

Performing arts directors, and academic advisors will create their own schedules.

Students will be released from school for events/games at the discretion of the Principal.

Only the Athletic Director, Superintendent or Principal may postpone or cancel games.

13

TRANSPORTATION

Transportation for athletic events will be arranged by the Athletic Director and communicated to the appropriate coach.

Transportation for all other events will be the responsibility of the event director, advisor or teacher.

Students must travel to and from competitions or performances in transportation provided by the school district, with the only exceptions being as follows:

1. Injury to the student, which may require alternate transportation.

2. Prior arrangement made in writing between the participant’s parent, athleticdirector, and coach/advisor for the student to ride with a parent/guardian.

FUNDRAISING

All fundraising must be approved in advance by the Principal.

AWARDS AND RECOGNITION – LETTERS AND PINS

Awards will be given at the head coach’s discretion or academic advisors discretion. Letter requirements vary among each particular sport/extracurricular activity. Students in grades 9-12 are eligible to receive a varsity athletic letter and/or pin and the coach will explain how to achieve them.

REQUIRED STUDENT/PARENT SCHOOL-SPONSORED ACTIVITIES HANDBOOK SIGNATURES

1. Students and parents must sign and submit Student/Parent Handbook School-SponsoredActivities Signature form to his/her coach, director or advisor.

14

FOR STUDENT ATHLETES ONLY

OBLIGATIONS PRIOR TO START OF SEASON

Students planning on participating in a Girard School District interscholastic/extracurricular school sponsored sport (Middle and High School) must satisfy the following requirements prior to the start of their particular season. The Pre-Participation Physical Packet is available in the school office:

1. Completed (ALL SECTIONS) Comprehensive Initial Pre-Participation Physical Examination(CIPPE).

The student and parent/guardian MUST READ and complete ALL the information requested PRIOR to reporting for the physical examination. Again, do not leave lines blank – ALL the information is important.

• Physicals are required prior to start of season and are provided annually by the schooldistrict on or after June 1st or by your private physician.

o Students who have a yearly physical through their family doctor, should alwayshave this exam after June 1st for insurance and PIAA purposes. Please adjustyour dates, if needed.

• If injured, must be re-certified, by the school district’s authorized medical examinerand/or physician, before each of the following seasons within the same school year.

2. Signed Release & Waiver of Liability Form

3. Completed Personal & Emergency Medical Information Section of CIPPE

4. Satisfied eligibility requirements for both the PIAA and GSD

• Listed in this Handbook• On the PIAA website (www.PIAA.org)• Determined by the school administration

5. All athletes must take a free C3 test (computerized concussion evaluation system), prior totheir first practice.

15

PIAA SPECIFIC REGULATIONS FOR STUDENT ATHLETES

In addition to GSD regulations, student-athletes must also comply with PIAA regulations.

PIAA ELIGIBILITY - AGE

A student shall be ineligible for interscholastic athletic competition upon attaining the age of nineteen years, with the following exception:

• If the age of nineteen is attained on or after July 1, the student shall be eligible, age-wise,to compete through that school year.

PIAA ELIGIBILITY - ATTENDANCE

A student, who has been absent from school during a semester for a total of twenty or more school days, shall not be eligible to participate in an inter-school practice, scrimmage, or contest until the student has been in attendance for a total of forty-five school days following the twentieth day of absence.

PIAA ELIGIBILITY - ACADEMICS

A student must pursue a curriculum defined and approved by the principal as a full-time curriculum. A student must also have passed at least four full-credit subjects, or the equivalent, during the previous grading period. (see the GSD Eligibility – Academics).

PIAA RULES & REGULATIONS

For student athletes that are ejected from a contest, by a PIAA official, for unsportsmanlike conduct or flagrant misconduct shall be disqualified from participating for the remainder of the day and in the next contest on the next play day at the same level.

Following the disqualification and prior to his/her return to participation, the student athlete will meet with the athletic director/principal. If it is determined that the GSD Student Code of Conduct was violated, school discipline may also be administered.

16

HEALTH, MEDICATIONS AND PHYSICAL EXAMINATIONS, INCLUDING CIPPE FORM

The PIAA and GSD require athletes to have a Comprehensive Initial Pre-Participation Physical Examination (CIPPE).

INITIAL EVALUATION: Prior to any student participating in Practices, Inter-School Practices, Scrimmages, and/or Contests, at any PIAA member school in any school year, the student is required to:

(1) complete a Comprehensive Initial Pre- Participation Physical Evaluation (CIPPE); and

(2) have the appropriate person(s) complete the first six Sections of the CIPPE Form.

Upon completion of Sections 1 and 2 by the parent/guardian;

Sections 3, 4, and 5 by the student and parent/guardian; and

Section 6 by an Authorized Medical Examiner (AME), those Sections must be turned in to the Athletic Director of the student's school for retention by the school.

Section 7 will only be completed when a student-athlete competes in more than one sport season. When a student-athlete decides to participate in a second or third sport during the school year, he/she will contact the Athletic Director to get Section 7. Complete and return Section 7 to the Athletic Director for review. If there were no significant injuries suffered in the previous season, the student-athlete will be eligible to compete.

Section 8 – if there was an injury suffered, the student-athlete MUST have Section 8 completed by a doctor (as per regulations listed).

Section 9 – Wrestling: Section 9 will be completed by the trainer and the doctor for students that are involved with the wrestling program.

Make sure Sections 1,2,3,4 and 5 are completed when your son or daughter comes in for their physical. If these sections are not completed, it may result in your child not receiving their physical.

The CIPPE may not be authorized earlier than June 1st and shall be effective for the entireschool year and will expire on May 31st or at the conclusion of the spring sports season.

SUBSEQUENT SPORT(S) IN THE SAME SCHOOL YEAR: Following completion of a CIPPE, the same student seeking to participate in Practices, Inter-School Practices, Scrimmages, and/or Contests in subsequent sport(s) in the same school year, must complete Section 7 of this form and must turn in that Section to the Principal, or Principal’s designee, of his or her school. The Principal, or the Principal’s designee, will then determine whether Section 8 need be completed.

17

All athletes must take a free C3 test (computerized concussion evaluation system), prior to their first practice. See the athletic trainer or coach for more information.

The athletic director/school nurse will make arrangements with school’s physician for physical examinations.

The head coach and/or delegated assistant(s) will confirm that all candidates have this CIPPE or re-certification prior to any participation.

The School Nurse, Athletic Trainer, and/or licensed medical practitioner will dispense all medications. Coaches and assistants will not dispense medications.

The GDS provides an athletic trainer, who is certified by the National Athletic Trainers’ Association. This individual is responsible for the prevention, treatment, and rehabilitation of athletic medical injuries/illnesses. The athletic trainer is also available for educating, counseling, and making referrals regarding the health and well-being of student athletes.

NCAA DIVISION I OR DIVISION II INITIAL-ELIGIBILITY

Any recruitment of Girard School District students who are eligible for college or university athletic participation must be conducted within NCAA recruitment guidelines. Students should contact the counseling office during their junior year to begin the registration process with the NCAA Clearinghouse.

For additional information, students/parents may refer to the current Student Scheduling Guide, see a grade level counselor in the Counseling Department, or contact the NCAA Clearinghouse at (877) 262-1492 or at https://www.eligibilitycenter.org

18

CLEARANCES / REQUIREMENTS, EMPLOYMENT AND VOLUNTEERS

According to Pennsylvania Department of Education (PDE), anyone working or volunteering with children in public or private schools is required to provide proof of the following clearances and documentation: Employment Requirements:

1. PA State Criminal Clearance; submit online at https://epatch.state.pa.us2. PA Child Abuse History Clearance; submit online at www.compass.state.pa.us/cwis3. FBI Fingerprint Criminal Background Check; pre-register online

https://uenroll.identogo.com and use Service Code 1KG6XN4. Child Abuse Recognition Training Certificate; free and available at

www.reportabusepa.pitt.edu5. School Personnel Health Record with completed Tuberculin (TB) test and physical

results; form available in school office. TB Test must be administered within the priorthree months.

6. Arrest/Conviction Report and Certification Form; form available in school office.7. Sexual Misconduct/Abuse Disclosure Release(s); form available in school office.

Volunteer Requirements: When applying be sure to apply as “volunteer”; this will waive the fee for PA Criminal History and PA Child Abuse History Clearances.

1. PA State Criminal Clearance; submit online at https://epatch.state.pa.us2. PA Child Abuse History Clearance; submit online at www.compass.state.pa.us/cwis3. FBI Fingerprint Criminal Background Check; pre-register online

https://uenroll.identogo.com and use Service Code 1KG6Y3a. There is a waiver/affidavit for this if you have been a Pennsylvania resident for

the entire previous ten (10) consecutive years and have not been convicted ofcertain offenses. Waivers are available in the school office.

4. Child Abuse Recognition Training Certificate; free and available atwww.reportabusepa.pitt.edu

5. School Personnel Health Record with completed Tuberculin (TB) test; form available inschool office. TB Test must be administered within the prior three months.

Additional Coach Requirements: 1. Concussion Training Certificate;

http://www.nfhslearn.com/electiveDetail.aspx?courseID=380002. Sudden Cardiac Arrest Training Certificate; https://nfhslearn.com/courses/61032*All coach clearances and forms are to be submitted to the Board approved eventscheduler at Girard High School.3. Signed Job Description – required yearly

All clearances must be dated within five (5) years prior to hire date or start of volunteering and will need to be renewed every five (5) years with continuous service. If there is a break in service with Girard School District, new clearances will be required.

Any person employed or volunteering in the Girard School District must maintain current clearances on file at the Administration Office. It is his/her responsibility to apply for the clearances and provide them on time to the administration office. Failure to do so may result in termination from your position.

19

***Please keep the Student/Parent Handbook for your records. All of the following pages, including this page, must be completed and submitted to the Athletic Director one week before your first practice. The Student-Athlete and Parent (or legal guardian) MUST READ and complete ALL the information requested PRIOR to reporting for their physical examination!

Girard School District

2020-2021 Pre-Participation Physical Packet Athlete’s Name: ___________________________________

Grade in 2020-2021: ________

Fall Sport: _________________

Winter Sport: ______________

Spring Sport: _______________

All athletes must take a free C3 test (computerized concussion evaluation system), prior to their first practice. Please see the athletic trainer or your coach for more information.

20

Dear Parents and Student-Athletes,

*Sections 1, 2, 3, 4, and 5 must be completed before the physical evaluation.

*Section 5 will be reviewed by the doctor and the doctor will complete Section 6.

*Section 7 will only be completed when a student-athlete competes in more thanone sport season. When a student athlete decides to participate in a second orthird sport during the school year, he/she will contact the AD to get their physicalpacket. Once they have that packet, they will complete Section 7 and return it tome for review. If there were no significant injuries suffered in the previous season,the student-athlete will be eligible to compete. It’s that simple!

*If there was an injury suffered, the student athlete will have to have Section 8completed by a doctor (probably the doctor who took care of the injury). Section9 will be completed by the trainer and the doctor for students that are involvedwith wrestling.

Please make sure that Sections 1, 2, 3, 4, and 5 are completed when your son or daughter comes in for their physical. If these sections are not completed, it may result in your son or daughter not receiving their physical. If you have any questions about the pre-participation physical packet, please contact me.

Thanks and Good Luck!

Mark S. Amenta Athletic Director Girard School District (814)-774-5607 x 6402 mark.amenta@girardsd.org

21

Revised: March 22, 2017

PIAA COMPREHENSIVE INITIAL PRE-PARTICIPATION PHYSICAL EVALUATION

INITIAL EVALUATION: Prior to any student participating in Practices, Inter-School Practices, Scrimmages, and/or Contests, at any PIAA member school in any school year, the student is required to (1) complete a Comprehensive Initial Pre-Participation Physical Evaluation (CIPPE); and (2) have the appropriate person(s) complete the first six Sections of the CIPPE Form. Upon completion of Sections 1 and 2 by the parent/guardian; Sections 3, 4, and 5 by the student and parent/guardian; and Section 6 by an Authorized Medical Examiner (AME), those Sections must be turned in to the Principal, or the Principal’s designee, of the student's school for retention by the school. The CIPPE may not be authorized earlier than June 1

st and shall be effective, regardless of when performed during a school year, until the latter of the next

May 31st

or the conclusion of the spring sports season.

SUBSEQUENT SPORT(S) IN THE SAME SCHOOL YEAR: Following completion of a CIPPE, the same student seeking to participate in Practices, Inter-School Practices, Scrimmages, and/or Contests in subsequent sport(s) in the same school year, must complete Section 7 of this form and must turn in that Section to the Principal, or Principal’s designee, of his or her school. The Principal, or the Principal’s designee, will then determine whether Section 8 need be completed.

SECTION 1: PERSONAL AND EMERGENCY INFORMATION

PERSONAL INFORMATION

Student’s Name Male/Female (circle one)

Date of Student’s Birth: ____/____/_______ Age of Student on Last Birthday: ____ Grade for Current School Year: ____

Current Physical Address

Current Home Phone # ( ) Parent/Guardian Current Cellular Phone # ( )

Fall Sport(s): ___________________ Winter Sport(s): ____________________ Spring Sport(s): ____________________

EMERGENCY INFORMATION

Parent’s/Guardian’s Name Relationship

Address Emergency Contact Telephone # ( )

Secondary Emergency Contact Person’s Name Relationship

Address Emergency Contact Telephone # ( )

Medical Insurance Carrier Policy Number

Address Telephone # ( )

Family Physician’s Name , MD or DO (circle one)

Address Telephone # ( )

Student’s Allergies

Student’s Health Condition(s) of Which an Emergency Physician or Other Medical Personnel Should be Aware

Student’s Prescription Medications and conditions of which they are being prescribed

22

SECTION 2: CERTIFICATION OF PARENT/GUARDIAN

The student’s parent/guardian must complete all parts of this form.

A. I hereby give my consent for _______________________________________________ born on ________________who turned ______ on his/her last birthday, a student of ____________________________________________ Schooland a resident of the ______________________________________________________________ public school district,to participate in Practices, Inter-School Practices, Scrimmages, and/or Contests during the 20____ - 20____ school yearin the sport(s) as indicated by my signature(s) following the name of the said sport(s) approved below.

Fall Sports

Signature of Parent or Guardian

Cross Country Field Hockey Football Golf Soccer Girls’ Tennis Girls’ Volleyball Water Polo Other

Winter Sports

Signature of Parent or Guardian

Basketball Bowling Competitive Spirit Squad Girls’ Gymnastics Rifle Swimming and Diving Track & Field (Indoor) Wrestling Other

Spring Sports

Signature of Parent or Guardian

Baseball Boys’ Lacrosse Girls’ Lacrosse Softball Boys’ Tennis Track & Field (Outdoor) Boys’ Volleyball Other

B. Understanding of eligibility rules: I hereby acknowledge that I am familiar with the requirements of PIAAconcerning the eligibility of students at PIAA member schools to participate in Inter-School Practices, Scrimmages, and/orContests involving PIAA member schools. Such requirements, which are posted on the PIAA Web site at www.piaa.org,include, but are not necessarily limited to age, amateur status, school attendance, health, transfer from one school toanother, season and out-of-season rules and regulations, semesters of attendance, seasons of sports participation, andacademic performance.

Parent’s/Guardian’s Signature ______________________________________________________Date____/____/_____

C. Disclosure of records needed to determine eligibility: To enable PIAA to determine whether the herein namedstudent is eligible to participate in interscholastic athletics involving PIAA member schools, I hereby consent to the releaseto PIAA of any and all portions of school record files, beginning with the seventh grade, of the herein named studentspecifically including, without limiting the generality of the foregoing, birth and age records, name and residence addressof parent(s) or guardian(s), residence address of the student, health records, academic work completed, grades received,and attendance data.

Parent’s/Guardian’s Signature ______________________________________________________Date____/____/_____

D. Permission to use name, likeness, and athletic information: I consent to PIAA’s use of the herein namedstudent’s name, likeness, and athletically related information in video broadcasts and re-broadcasts, webcasts and reportsof Inter-School Practices, Scrimmages, and/or Contests, promotional literature of the Association, and other materials andreleases related to interscholastic athletics.

Parent’s/Guardian’s Signature ______________________________________________________Date____/____/_____

E. Permission to administer emergency medical care: I consent for an emergency medical care provider toadminister any emergency medical care deemed advisable to the welfare of the herein named student while the student ispracticing for or participating in Inter-School Practices, Scrimmages, and/or Contests. Further, this authorization permits,if reasonable efforts to contact me have been unsuccessful, physicians to hospitalize, secure appropriate consultation, toorder injections, anesthesia (local, general, or both) or surgery for the herein named student. I hereby agree to pay forphysicians’ and/or surgeons’ fees, hospital charges, and related expenses for such emergency medical care. I furthergive permission to the school’s athletic administration, coaches and medical staff to consult with the Authorized MedicalProfessional who executes Section 6 regarding a medical condition or injury to the herein named student.

Parent’s/Guardian’s Signature ______________________________________________________Date____/____/_____

F. CONFIDENTIALITY: The information on this CIPPE shall be treated as confidential by school personnel. It may beused by the school’s athletic administration, coaches and medical staff to determine athletic eligibility, to identify medicalconditions and injuries, and to promote safety and injury prevention. In the event of an emergency, the informationcontained in this CIPPE may be shared with emergency medical personnel. Information about an injury or medicalcondition will not be shared with the public or media without written consent of the parent(s) or guardian(s).

Parent’s/Guardian’s Signature ______________________________________________________Date____/____/_____ 23

SECTION 3: UNDERSTANDING OF RISK OF CONCUSSION AND TRAUMATIC BRAIN INJURY

What is a concussion? A concussion is a brain injury that:

Is caused by a bump, blow, or jolt to the head or body. Can change the way a student’s brain normally works.

Can occur during Practices and/or Contests in any sport. Can happen even if a student has not lost consciousness. Can be serious even if a student has just been “dinged” or “had their bell rung.”

All concussions are serious. A concussion can affect a student’s ability to do schoolwork and other activities (such as playing video games, working on a computer, studying, driving, or exercising). Most students with a concussion get better, but it is important to give the concussed student’s brain time to heal.

What are the symptoms of a concussion? Concussions cannot be seen; however, in a potentially concussed student, one or more of the symptoms listed below may become apparent and/or that the student “doesn’t feel right” soon after, a few days after, or even weeks after the injury.

Headache or “pressure” in head

Nausea or vomiting Balance problems or dizziness Double or blurry vision Bothered by light or noise

Feeling sluggish, hazy, foggy, or groggy Difficulty paying attention Memory problems Confusion

What should students do if they believe that they or someone else may have a concussion?

Students feeling any of the symptoms set forth above should immediately tell their Coach and theirparents. Also, if they notice any teammate evidencing such symptoms, they should immediately tell their Coach.

The student should be evaluated. A licensed physician of medicine or osteopathic medicine (MD or DO),sufficiently familiar with current concussion management, should examine the student, determine whether thestudent has a concussion, and determine when the student is cleared to return to participate in interscholasticathletics.

Concussed students should give themselves time to get better. If a student has sustained a concussion, thestudent’s brain needs time to heal. While a concussed student’s brain is still healing, that student is much morelikely to have another concussion. Repeat concussions can increase the time it takes for an already concussedstudent to recover and may cause more damage to that student’s brain. Such damage can have long termconsequences. It is important that a concussed student rest and not return to play until the student receivespermission from an MD or DO, sufficiently familiar with current concussion management, that the student issymptom-free.

How can students prevent a concussion? Every sport is different, but there are steps students can take to protect themselves.

Use the proper sports equipment, including personal protective equipment. For equipment to properly protect astudent, it must be:

The right equipment for the sport, position, or activity; Worn correctly and the correct size and fit; and Used every time the student Practices and/or competes.

Follow the Coach’s rules for safety and the rules of the sport.

Practice good sportsmanship at all times.

If a student believes they may have a concussion: Don’t hide it. Report it. Take time to recover.

I hereby acknowledge that I am familiar with the nature and risk of concussion and traumatic brain injury while participating in interscholastic athletics, including the risks associated with continuing to compete after a concussion or traumatic brain injury.

Student’s Signature _________________________________________________________________________Date____/____/_____

I hereby acknowledge that I am familiar with the nature and risk of concussion and traumatic brain injury while participating in interscholastic athletics, including the risks associated with continuing to compete after a concussion or traumatic brain injury.

Parent’s/Guardian’s Signature _______________________________________________________________Date____/____/_____24

PA Department of Health: Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet and Acknowledgement of Receipt and Review Form. 7/2012

SECTION 4: UNDERSTANDING OF SUDDEN CARDIAC ARREST SYMPTOMS AND WARNING SIGNS

What is sudden cardiac arrest? Sudden cardiac arrest (SCA) is when the heart stops beating, suddenly and unexpectedly. When this happens blood stops flowing to the brain and other vital organs. SCA is NOT a heart attack. A heart attack may cause SCA, but they are not the same. A heart attack is caused by a blockage that stops the flow of blood to the heart. SCA is a malfunction in the heart’s electrical system, causing the heart to suddenly stop beating. How common is sudden cardiac arrest in the United States? There are about 300,000 cardiac arrests outside hospitals each year. About 2,000 patients under 25 die of SCA each year. Are there warning signs? Although SCA happens unexpectedly, some people may have signs or symptoms, such as:

dizziness lightheadedness shortness of breath difficulty breathing racing or fluttering heartbeat (palpitations) syncope (fainting)

fatigue (extreme tiredness) weakness nausea vomiting chest pains

These symptoms can be unclear and confusing in athletes. Often, people confuse these warning signs with physical exhaustion. SCA can be prevented if the underlying causes can be diagnosed and treated. What are the risks of practicing or playing after experiencing these symptoms? There are risks associated with continuing to practice or play after experiencing these symptoms. When the heart stops, so does the blood that flows to the brain and other vital organs. Death or permanent brain damage can occur in just a few minutes. Most people who have SCA die from it. Act 59 – the Sudden Cardiac Arrest Prevention Act (the Act) The Act is intended to keep student-athletes safe while practicing or playing. The requirements of the Act are:

Information about SCA symptoms and warning signs.

Every student-athlete and their parent or guardian must read and sign this form. It must be returned to the school before participation in any athletic activity. A new form must be signed and returned each school year.

Schools may also hold informational meetings. The meetings can occur before each athletic season. Meetings may include student-athletes, parents, coaches and school officials. Schools may also want to include doctors, nurses, and athletic trainers.

Removal from play/return to play

Any student-athlete who has signs or symptoms of SCA must be removed from play. The symptoms can happen before, during, or after activity. Play includes all athletic activity.

Before returning to play, the athlete must be evaluated. Clearance to return to play must be in writing. The evaluation must be performed by a licensed physician, certified registered nurse practitioner, or cardiologist (heart doctor). The licensed physician or certified registered nurse practitioner may consult any other licensed or certified medical professionals.

I have reviewed and understand the symptoms and warning signs of SCA. ______________________________________ ___________________________________ Date____/____/_____ Signature of Student-Athlete Print Student-Athlete’s Name ______________________________________ ___________________________________ Date____/____/_____ Signature of Parent/Guardian Print Parent/Guardian’s Name

25

Student’s Name Age Grade

SECTION 5: HEALTH HISTORY

Yes No 1. Has a doctor ever denied or restricted your

participation in sport(s) for any reason?2. Do you have an ongoing medical condition

(like asthma or diabetes)?3. Are you currently taking any prescription or

nonprescription (over-the-counter) medicinesor pills?

4. Do you have allergies to medicines,pollens, foods, or stinging insects?

5. Have you ever passed out or nearlypassed out DURING exercise?

6. Have you ever passed out or nearlypassed out AFTER exercise?

7. Have you ever had discomfort, pain, orpressure in your chest during exercise?

8. Does your heart race or skip beats duringexercise?

9. Has a doctor ever told you that you have(check all that apply):

High blood pressure Heart murmur High cholesterol Heart infection

10. Has a doctor ever ordered a test for yourheart? (for example ECG, echocardiogram)

11. Has anyone in your family died for noapparent reason?

12. Does anyone in your family have a heartproblem?

13. Has any family member or relative beendisabled from heart disease or died of heartproblems or sudden death before age 50?

14. Does anyone in your family have Marfansyndrome?

15. Have you ever spent the night in ahospital?

16. Have you ever had surgery?17. Have you ever had an injury, like a sprain,

muscle, or ligament tear, or tendonitis, whichcaused you to miss a Practice or Contest?If yes, circle affected area below:

18. Have you had any broken or fracturedbones or dislocated joints? If yes, circlebelow:

19. Have you had a bone or joint injury thatrequired x-rays, MRI, CT, surgery, injections,rehabilitation, physical therapy, a brace, acast, or crutches? If yes, circle below:

Head Neck Shoulder Upper arm

Elbow Forearm Hand/ Fingers

Chest

Upper back

Lower back

Hip Thigh Knee Calf/shin Ankle Foot/ Toes

20. Have you ever had a stress fracture?21. Have you been told that you have or have

you had an x-ray for atlantoaxial (neck)instability?

22. Do you regularly use a brace or assistivedevice?

Yes No 23. Has a doctor ever told you that you have

asthma or allergies?24. Do you cough, wheeze, or have difficulty

breathing DURING or AFTER exercise?25. Is there anyone in your family who has

asthma?26. Have you ever used an inhaler or taken

asthma medicine?27. Were you born without or are your missing

a kidney, an eye, a testicle, or any otherorgan?

28. Have you had infectious mononucleosis(mono) within the last month?

29. Do you have any rashes, pressure sores,or other skin problems?

30. Have you ever had a herpes skininfection?

CONCUSSION OR TRAUMATIC BRAIN INJURY 31. Have you ever had a concussion (i.e. bell

rung, ding, head rush) or traumatic braininjury?

32. Have you been hit in the head and beenconfused or lost your memory?

33. Do you experience dizziness and/orheadaches with exercise?

34. Have you ever had a seizure?35. Have you ever had numbness, tingling, or

weakness in your arms or legs after being hitor falling?

36. Have you ever been unable to move yourarms or legs after being hit or falling?

37. When exercising in the heat, do you havesevere muscle cramps or become ill?

38. Has a doctor told you that you or someonein your family has sickle cell trait or sickle celldisease?

39. Have you had any problems with youreyes or vision?

40. Do you wear glasses or contact lenses?41. Do you wear protective eyewear, such as

goggles or a face shield?42. Are you unhappy with your weight?43. Are you trying to gain or lose weight?44. Has anyone recommended you change

your weight or eating habits?45. Do you limit or carefully control what you

eat?46. Do you have any concerns that you would

like to discuss with a doctor?FEMALES ONLY 47. Have you ever had a menstrual period?48. How old were you when you had your first

menstrual period?49. How many periods have you had in the

last 12 months?50. Are you pregnant?

#’s Explain “Yes” answers here:

I hereby certify that to the best of my knowledge all of the information herein is true and complete.

Student’s Signature _________________________________________________________________________Date____/____/_____ I hereby certify that to the best of my knowledge all of the information herein is true and complete.

Parent’s/Guardian’s Signature _________________________________________________________________Date____/____/_____

Explain “Yes” answers at the bottom of this form. Circle questions you don’t know the answers to.

26

SECTION 6: PIAA COMPREHENSIVE INITIAL PRE-PARTICIPATION PHYSICAL EVALUATION AND CERTIFICATION OF AUTHORIZED MEDICAL EXAMINER

Must be completed and signed by the Authorized Medical Examiner (AME) performing the herein named student’s comprehensive initial pre-participation physical evaluation (CIPPE) and turned in to the Principal, or the Principal’s designee, of the student's school.

Student’s Name Age Grade

Enrolled in _______________________________________ School Sport(s)

Height_______ Weight______ % Body Fat (optional) ______ Brachial Artery BP_____/_____ (_____/_____ , _____/_____) RP_______

If either the brachial artery blood pressure (BP) or resting pulse (RP) is above the following levels, further evaluation by the student’s primary care physician is recommended. Age 10-12: BP: >126/82, RP: >104; Age 13-15: BP: >136/86, RP >100; Age 16-25: BP: >142/92, RP >96. Vision: R 20/_____ L 20/_____ Corrected: YES NO (circle one) Pupils: Equal_____ Unequal_____

MEDICAL NORMAL ABNORMAL FINDINGS

Appearance

Eyes/Ears/Nose/Throat

Hearing

Lymph Nodes

Cardiovascular Heart murmur Femoral pulses to exclude aortic coarctation Physical stigmata of Marfan syndrome

Cardiopulmonary

Lungs

Abdomen

Genitourinary (males only)

Neurological

Skin

MUSCULOSKELETAL NORMAL ABNORMAL FINDINGS

Neck

Back

Shoulder/Arm

Elbow/Forearm

Wrist/Hand/Fingers

Hip/Thigh

Knee

Leg/Ankle

Foot/Toes

I hereby certify that I have reviewed the HEALTH HISTORY, performed a comprehensive initial pre-participation physical evaluation of the herein named student, and, on the basis of such evaluation and the student’s HEALTH HISTORY, certify that, except as specified below, the student is physically fit to participate in Practices, Inter-School Practices, Scrimmages, and/or Contests in the sport(s) consented to by the student’s parent/guardian in Section 2 of the PIAA Comprehensive Initial Pre-Participation Physical Evaluation form:

CLEARED CLEARED, with recommendation(s) for further evaluation or treatment for:

NOT CLEARED for the following types of sports (please check those that apply): COLLISION CONTACT NON-CONTACT STRENUOUS MODERATELY STRENUOUS NON-STRENUOUS

Due to

Recommendation(s)/Referral(s)

AME’s Name (print/type) License # Address______________________________________________________________________ Phone ( )

AME’s Signature____________________MD, DO, PAC, CRNP, or SNP (circle one) Certification Date of CIPPE ___/____/___ 27

SECTION 7: RE-CERTIFICATION BY PARENT/GUARDIAN

This form must be completed not earlier than six weeks prior to the first Practice day of the sport(s) in the sports season(s) identified herein by the parent/guardian of any student who is seeking to participate in Practices, Inter-School Practices, Scrimmages, and/or Contests in all subsequent sport seasons in the same school year. The Principal, or the Principal’s designee, of the herein named student’s school must review the SUPPLEMENTAL HEALTH HISTORY.

If any SUPPLEMENTAL HEALTH HISTORY questions are either checked yes or circled, the herein named student shall submit a completed Section 8, Re-Certification by Licensed Physician of Medicine or Osteopathic Medicine, to the Principal, or Principal’s designee, of the student’s school.

SUPPLEMENTAL HEALTH HISTORY

Student’s Name Male/Female (circle one)

Date of Student’s Birth: ______/______/_________ Age of Student on Last Birthday: ______ Grade for Current School Year: ______

Winter Sport(s): ________________________________________ Spring Sport(s): ________________________________________ CHANGES TO PERSONAL INFORMATION (In the spaces below, identify any changes to the Personal Information set forth in the original Section 1: PERSONAL AND EMERGENCY INFORMATION):

Current Home Address

Current Home Telephone # ( ) Parent/Guardian Current Cellular Phone # ( )

CHANGES TO EMERGENCY INFORMATION (In the spaces below, identify any changes to the Emergency Information set forth in the original Section 1: PERSONAL AND EMERGENCY INFORMATION):

Parent’s/Guardian’s Name Relationship

Address Emergency Contact Telephone # ( )

Secondary Emergency Contact Person’s Name Relationship

Address Emergency Contact Telephone # ( )

Medical Insurance Carrier Policy Number

Address Telephone # ( )

Family Physician’s Name , MD or DO (circle one)

Address Telephone # ( )

SUPPLEMENTAL HEALTH HISTORY:

Explain “Yes” answers at the bottom of this form. Circle questions you don’t know the answers to. Yes No 1. Since completion of the CIPPE, have you

sustained an illness and/or injury that required medical treatment from a licensed physician of medicine or osteopathic medicine?

2. Since completion of the CIPPE, have you had a concussion (i.e. bell rung, ding, head rush) or traumatic brain injury?

3. Since completion of the CIPPE, have you experienced dizzy spells, blackouts, and/or unconsciousness?

Yes No 4. Since completion of the CIPPE, have you

experienced any episodes of unexplained shortness of breath, wheezing, and/or chest pain?

5. Since completion of the CIPPE, are you taking any NEW prescription medicines or pills?

6. Do you have any concerns that you would like to discuss with a physician?

#’s Explain “Yes” answers here:

I hereby certify that to the best of my knowledge all of the information herein is true and complete.

Student’s Signature _________________________________________________________________________Date____/____/_____

I hereby certify that to the best of my knowledge all of the information herein is true and complete.

Parent’s/Guardian’s Signature _________________________________________________________________Date____/____/_____ 28

Section 8: Re-CERTIFICATION BY LICENSED PHYSICIAN OF MEDICINE OR OSTEOPATHIC MEDICINE

This Form must be completed for any student who, subsequent to completion of Sections 1 through 6 of this CIPPE Form, required medical treatment from a licensed physician of medicine or osteopathic medicine. This Section 8 may be completed at any time following completion of such medical treatment. Upon completion, the Form must be turned in to the Principal, or the Principal’s designee, of the student's school, who, pursuant to ARTICLE X, LOCAL MANAGEMENT AND CONTROL, Section 2, Powers and Duties of Principal, subsection C, of the PIAA Constitution, shall “exclude any contestant who has suffered serious illness or injury until that contestant is pronounced physically fit by the school’s licensed physician of medicine or osteopathic medicine, or if none is employed, by another licensed physician of medicine or osteopathic medicine.”

NOTE: The physician completing this Form must first review Sections 5 and 6 of the herein named student's previously completed CIPPE Form. Section 7 must also be reviewed if both (1) this Form is being used by the herein named student to participate in Practices, Inter-School Practices, Scrimmages, and/or Contests in a subsequent sport season in the same school year AND (2) the herein named student either checked yes or circled any Supplemental Health History questions in Section 7.

If the physician completing this Form is clearing the herein named student subsequent to that student sustaining a concussion or traumatic brain injury, that physician must be sufficiently familiar with current concussion management such that the physician can certify that all aspects of evaluation, treatment, and risk of that injury have been thoroughly covered by that physician.

Student's Name: Age Grade

Enrolled in __________________________________________________________________________________School

Condition(s) Treated Since Completion of the Herein Named Student’s CIPPE Form:

A. GENERAL CLEARANCE: Absent any illness and/or injury, which requires medical treatment, subsequent to thedate set forth below, I hereby authorize the above-identified student to participate for the remainder of the current schoolyear in additional interscholastic athletics with no restrictions, except those, if any, set forth in Section 6 of that student’sCIPPE Form.

Physician’s Name (print/type)__________________________________________________ License #_______________

Address___________________________________________________________________ Phone ( )____________

Physician’s Signature _____________________________________________MD or DO (circle one) Date____________

B. LIMITED CLEARANCE: Absent any illness and/or injury, which requires medical treatment, subsequent to the dateset forth below, I hereby authorize the above-identified student to participate for the remainder of the current school yearin additional interscholastic athletics with, in addition to the restrictions, if any, set forth in Section 6 of that student’sCIPPE Form, the following limitations/restrictions:

1.

2.

3.

4.

Physician’s Name (print/type)__________________________________________________ License #_______________

Address__________________________________________________________________ Phone ( )____________

Physician’s Signature _____________________________________________MD or DO (circle one) Date____________ 29

Section 9: CIPPE MINIMUM WRESTLING WEIGHT

INSTRUCTIONS Pursuant to the Weight Control Program adopted by PIAA, prior to the participation by any student in interscholastic wrestling, the Minimum Wrestling Weight (MWW) at which the student may wrestle during the season must be (1) certified to by an Authorized Medical Examiner (AME) and (2) established NO EARLIER THAN six weeks prior to the first Regular Season Contest day of the wrestling season and NO LATER THAN the Monday preceding the first Regular Season Contest day of the wrestling season (See NOTE 1). This certification shall be provided to and maintained by the student’s Principal, or the Principal’s designee. In certifying to the MWW, the AME shall first make a determination of the student's Urine Specific Gravity/Body Weight and Percentage of Body Fat, or shall be given that information from a person authorized to make such an assessment ("the Assessor"). This determination shall be made consistent with National Federation of State High School Associations (NFHS) Wrestling Rule 1, Competition, Section 3, Weight-Control Program, which requires, in relevant part, hydration testing with a specific gravity not greater than 1.025, and an immediately following body fat assessment, as determined by the National Wrestling Coaches Association (NWCA) Optimal Performance Calculator (OPC) (together, the “Initial Assessment”). Where the Initial Assessment establishes a percentage of body fat below 7% for a male or 12% for a female, the student must obtain an AME’s consent to participate. For all wrestlers, the MWW must be certified to by an AME.

Student’s Name Age Grade

Enrolled in __________________________________________________________________________________ School INITIAL ASSESSMENT I hereby certify that I have conducted an Initial Assessment of the herein named student consistent with the NWCA OPC, and have determined as follows: Urine Specific Gravity/Body Weight ________/________ Percentage of Body Fat _________ MWW ________________

Assessor’s Name (print/type)_____________________________________________Assessor’s I.D. #_______________

Assessor’s Signature____________________________________________________________Date_____/_____/_____

CERTIFICATION Consistent with the instructions set forth above and the Initial Assessment, I have determined that the herein named student is certified to wrestle at the MWW of ________________ during the 20____ - 20____ wresting season. AME’s Name (print/type) License # Address Phone ( ) AME’s Signature________________________________MD, DO, PAC, CRNP, or SNP Date of Certification ___/___/___ (circle one) For an appeal of the Initial Assessment, see NOTE 2.

NOTES: 1. For senior high school wrestlers coming out for the Team AFTER the Monday preceding the first Regular Season Contest day of the wrestling season the OPC will remain open until January 15th and for junior high/middle school wrestlers coming out for the Team AFTER the Monday preceding the first Regular Season Contest day of the wrestling season the OPC will remain open all season. 2. Any athlete who disagrees with the Initial Assessment may appeal the assessment results one time by having a second assessment, which shall be performed prior to the athlete’s first Regular Season wrestling Contest and shall be consistent with the athlete’s weight loss (descent) plan. Pursuant to the foregoing, results obtained at the second assessment shall supersede the Initial Assessment; therefore, no further appeal by any party shall be permitted. The second assessment shall utilize either Air Displacement Plethysmography (Bod Pod) or Hydrostatic Weighing testing to determine body fat percentage. The urine specific gravity testing shall be conducted and the athlete must obtain a result of less than or equal to 1.025 in order for the second assessment to proceed. All costs incurred in the second assessment shall be the responsibility of those appealing the Initial Assessment.

30

Girard School District Parental Agreement

PARENTAL CODE OF ETHICS

The purpose of this Code of Ethics is for you, the parent, to make a commitment to yourself, your child, and the people surrounding you at your child’s competitions and/or performances. It is important to remember that extracurricular school-sponsored activities are offered to provide fun and enjoyable team building activities for our students. These activities teach students lifetime skills such as teamwork, competition abilities, communication skills, good character and overall skill development. Please take time to read below and make a commitment to your child’s experience.

• I will do my best to model good character at events by the way I treat officials, coaches,directors, advisors, students, parents, and other fans.

• I will insist that my child always demonstrate good character and treat the game,competition, performance, coaches, performing arts directors, advisors, officials andother participating students with respect.

• I will remember that I represent myself, my child, my child’s team and school at allschool sponsored events.

• I will always strive to work in a positive manner with my child’s coach, performing artsdirector, or advisor.

• I will always teach my child the importance of competing with integrity and will not helphim or her cheat in any manner.

• I will always keep in mind that it is a privilege, rather than a right, for my child toparticipate in any school sponsored event, and it is a privilege for me to watch.

• I will encourage my son/daughter to talk to their coach, performance director oradvisor if they have a problem with their extra-curricular experience.

• I will set up an appointment with an adult, following the GSD process, if I feel it isnecessary. I will approach a coach, director or advisor in an appropriate manner, and atan appropriate time.

• I will never put my child or another child down.• It is my responsibility to be a role model for my child and all children.

I understand School Administration will be the sole arbiters of interpretation, violation, and penalization of every aspect of the Code of Conduct. Consequences for violation will be levied according to the degree of the offense and may include removal from the event, barring from school grounds, facilities, properties, and events, and/or involvement of legal authorities.

Student’s Name:________________________________________________

Parent/Guardian Signature _______________________________ Date______________

31

Girard School District Student Code of Conduct

The below listed rules are enforced by the administration of the Girard School District. Student and Parent/Guardian will sign the Code of Conduct before the first meeting/practice.

All students, on or off school property, must adhere to:

• Girard School District Tobacco Use Policy• Girard School District Controlled Substance/Paraphernalia Policy• No possession or use of alcohol products

Violations will result in:

1st Offense is 2 weeks off the team, no practices, games or participation ofany kind.

2nd Offense, you are removed from the team for the remainder of thepresent season.

Inappropriate actions or behaviors that would put your character in question, or represent your team or the Girard School District in a negative manner will not be tolerated. At administrative discretion, any and all student behavior, whether school related or not, can affect a student’s ability to participate in school-sponsored activities. Students could be subject to suspension or removal from a team for the following season, depending when the violation took place. Students violating these rules are subject to additional punishment as per the school policy. All students are subject to their individual coach’s, performing arts director’s, or academic advisor’s rules as explained at the opening of the season.

I understand School Administration will be the sole arbiters of interpretation, violation, and penalization of every aspect of the Code of Conduct. Consequences for violation will be levied according to the degree of the offense and may include removal from the event, barring from school grounds, facilities, properties, and events, and/or involvement of legal authorities.

Student’s Name:__________________________________________________

__________________________________ _____________________________________ Student Signature Date Parent Signature Date

32

Girard School District

Release and Waiver of Liability I/We, the undersigned, being the parent(s) or guardian(s) of _________________________,

a student in the Girard School District, are fully aware of the injuries he or she could sustain by

participating in the athletic, performing arts, or academic program of the Girard School District.

Being fully aware of the risks involved in sports participation, or other extracurricular

participation, we are willing to assume these risks, and we agree that we will not hold the

Girard School District, its employees, coaches, or directors, responsible for any injuries which

may be sustained by our son or daughter as a result of his or her participation in the games,

practices, performance or travel connected with participation sponsored by the Girard School

District. We further understand and agree that this Release and Waiver is given in

consideration of the benefits which our child will receive from his/her participation and that we

intend to be legally bound hereby. This Release and Waiver is filed for this 2020-2021 school

year.

Parent/Guardian Name: ____________________________________________________

Parent/Guardian Signature: _________________________________________________

Address:

________________________________________________________________

Date: _____________ Phone: ________________Emergency Phone:________________

33

Girard School District Student/Parent Handbook – School-Sponsored Activities

Athletics, Performing Arts, Academic Competitions 2020-2021

The Parent/Guardian and Student Sign-Off Sheet must be completed and returned. The signatures of the parent/guardian and the student indicate that each has read, understands and agrees to abide by the stated policies and expectations within this handbook.

This document must be on file with the coach, performing arts director or academic advisor prior to the start of the official practice/season date.

As parent or guardian of ___________________________________________________, (Student’s full name - please print)

I/We have read and will support the policies and expectations of the Girard School District Student/Parent Handbook for Student Athletics & Interscholastic Competition / School-Sponsored Activities Handbook.

Signed_____________________________________ _____________________ (Student) (Date) Signed__________________________________ _____________________ (Parent or Guardian) (Date)

Please sign and return this form to the coach, director or advisor.

34

GIRARD SCHOOL DISTRICT Athletic Department

Participation Waiver for Communicable Diseases Including COVID-19 Recommendations for Athletic Participation

The COVID-19 pandemic has presented athletics across the world with a myriad of

challenges. The COVID-19 virus is a highly contagious illness that primarily attacks the upper respiratory system. The virus that causes COVID-19 can infect people of all ages. Research from the Centers for Disease Control, among others, has found that while children do get infected by COVID-19, relatively few children with COVID-19 are hospitalized. However, some severe outcomes have been reported in children, and a child with a mild or even asymptomatic case of COVID-19 can spread the infection to others who may be far more vulnerable. While it is not possible to eliminate all risk of furthering the spread of COVID-19, the current science suggests there are many steps schools can take to reduce the risks to students, coaches, and their families.

The Girard School District will take the necessary precautions and recommendations

from the federal, state, and local governments, CDC, PA DOH, as well as the NFHS and PIAA. The Girard School District realizes the knowledge regarding COVID-19 is constantly changing as new information and treatments become available. These recommendations will be adjusted as needed as new information becomes available in order to decrease the risk of exposure for our staff, students, and spectators.

These recommendations include but may not be limited to:

1. Athletes, Coaches, and Staff will undergo a COVID- 19 health screening prior to any practice, event, or team meeting. The type of screening will be dependent upon the available resources and the Phase level. The purpose is to check for signs and symptoms of COVID-19. It will include a questionnaire and temperature check as needed.

2. Promote healthy hygiene practices such as hand washing, using hand sanitizer, cough in your elbow, avoid touching eyes, nose, face and mouth, no spitting, no gum chewing, No Handshakes/Celebrations (high fives, fist/elbow bumps, chest bumps, hugging)

3. Intensify cleaning, disinfection, and ventilation in all facilities 4. Encourage social distancing through increased spacing, small groups, and limited mixing

between groups, if feasible 5. Educate Athletes, Coaches, and Staff on health and safety protocols 6. Anyone who is sick must stay home 7. Plan in place if a student or employee gets sick 8. Regularly communicate and monitor developments with local authorities, employees, and

families regarding cases, exposures, and updates to policies and procedures 9. Athletes and Coaches MUST provide their own water bottle for hydration. Water bottles

must not be shared. Refill Stations and Water Fountains will NOT BE Initially AVAILABLE!

10. PPE (gloves, masks, eye protection) will be used as needed and situations warrant, or determined by local/state governments. Face Coverings will not be used for athletes while practicing or competing.

35

WAIVER AND RELEASE

In consideration for my student athlete being permitted to participate in Girard School District athletics during the 2020-2021 academic year during the COVID-19 pandemic, the undersigned, intending to be legally bound hereby, acknowledges and agrees to the following on behalf of themselves and on behalf of their minor children:

I understand and I acknowledge that my minor student athlete’s participation in athletic events during the COVID-19 pandemic may be inherently dangerous. I further acknowledge that even when conducted in an appropriate and proper manner, exposure to COVID-19 during an athletic event could cause injury to my person and/or property as well as the person or property of my minor student athlete. I hereby expressly assume the risk associated with all activities regarding my student athlete’s participation in interscholastic athletics, for myself and for my minor child.

I hereby for myself, my minor child, my heirs, administrators, and assigns specifically acknowledge and agree that the following persons and entities, including but not limited to, the School District, its official, agents, representatives, officers, directors, employees, members or affiliates of any person or entity named above (the “Releasees”) are not responsible for my safety nor the safety of my minor child and that I am fully responsible for my own safety and for the safety of my minor child during athletic participation, BEING FULLY AWARE OF THE RISKS, CONDITIONS, AND HAZARDS of my minor child’s participation in athletic activities and events, I specifically WAIVE, RELEASE, and DISCHARGE, in advance, for myself, my minor child, my heirs, administrators, and assigns, the Releasees above from any and all liability, whether known, or unknown, foreseen or unforeseen, including, but not limited to, damages for death, personal injury, or property damage, from any and all actions, causes of action, claims, damages, demands, injuries, medical expenses, and liability of any nature whatsoever, including reasonable attorney’s fees and interest, which may arise out of the negligence or carelessness on the part of the parties or entities mentioned above, or which may arise from the conditions, whether structural, man-made, natural or otherwise, of participation in athletic activities. I agree to accept all responsibilities for the risks, conditions, and hazards which may occur, whether they are known or unknown, whether they are apparent or not, whether they are foreseen or unforeseen on behalf of myself, my minor child, and my heirs.

BY SIGNING BELOW I ACKNOWLEDGE AND UNDERSTAND THE RISKS ASSOCIATED WITH MY MINOR CHILD’S PARTICIPATION IN THIS ACTIVITY AND I SPECIFICALLY RELEASE, DISCHARGE, AND WAIVE ALL ABOVE-MENTIONED RELEASEES OF ANY LIABILITY DESCRIBED ABOVE. I HAVE READ THIS WAIVER AND RELEASE, I UNDERSTAND THAT I HAVE GIVEN UP SUBSTANTIAL RIGHTS BY SIGNING IT AND IT SIGN IT VOLUNTARILY.

Sport: _____ ____________________________________

Signature of Parent/Guardian:_________________________________________ Date:______________

Signature of Student Athlete:__________________________________________ Date:______________ *Parents/Guardians may request a full copy of the Girard School District Resocialization ofSports Recommendations from Mark Amenta, GSD Athletic Director or Dave Swanson, GHSAssistant Principal

36

Please have a parent or guardian fill out the medical card below. The Sports Medicine Staff will only use this information to contact parent or guardian after serious illness or injury and with EMS staff, if necessary, to determine medical care. Thank You.

37