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Athletic Packet

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UKIAH HIGH SCHOOL

2018-19 SPORTS PARTICIPATION CHECKLIST

RETURN TO Attendance Office or Athletic Director

 

(Do not give to a coach)

 

          ______________________      ______      __________________             ________

                     Student’s Name               Grade                Sport(s)                           I.D. #


 

I have received, read and signed the following documents (PLEASE INITIAL NEXT TO EACH DOCUMENT or you will not be eligible to practice):

 

Athlete             Parent / Guardian

 

_______           ________       Physician Statement of Student Certification

 

_______           ________       Acknowledgement/Assumption of Potential Risk

 

_______           ________       Authorization & Consent for Medical Treatment and Health Insurance Verification

 

_______           ________       Concussion Information Sheet

 

_______           ________       NCS Ejection Policy

 

_______           ________       UUSD Extra-Curricular Rules & Regs/Student Contract

 

_______           ________       CIF Code of Conduct

 

_______           ________       Statements re: Hazing and Anabolic/Illegal Drug Use

 

_______           ________       Sudden Cardiac Arrest Notification Form

 

_______           ________       Complaint Procedure & Playing Time

 

_______           ________       I have watched the Video Clip “Positive Sport Parenting” online: Nfhslearn.com  

 

                         ________       Parent Code of Conduct

 

 

 

Signature of Parent/Guardian ________________________________________  Date   __________________

 

Signature of Athlete ________________________________________________  Date  __________________

 

 

----------------------------------------------------------------------------------------------------------------------------------------------------------------------

 

 

Physical Examination Information

 

The physical examination must be dated June 1st or later for the current school year. The physical examination is good until July 1 of the same school year. (i.e a physical exam for the 2018-19 school year is good until July 1, 2019)

 

It is very important that the above requested documents are turned in to the Attendance Office or A.D. at least a week or two before the beginning of the sport season. With the number of student-athletes and sports provided each season, it will normally take at least a week to process all the information. If you turn in the information on the first day of practice/tryouts, you will more than likely miss at least the first few days of practice/tryouts.  

 

RETURN TO Attendance Office or the Athletic Director

Physician’s Statement

 PARTICIPATION RECOMMENDATIONS

 

_____ 1. There were no history or physical findings on this exam which would prohibit this student from participating in competitive athletics.

 

_____ 2.  This student should have the following health problems evaluated or treated prior to participating in competitive athletics. (list below)

 

_____ 3.  This student has health problems which would prohibit him or her from participating in competitive athletics. 

 

 

PHYSICIAN’S STATEMENT CERTIFICATION

 

Are there apparent cavities in teeth?    _____ Yes        _____ No

Is there a bridge or false teeth?            _____  Yes       _____ No

 

Has the above had any injury or physical condition that should be watched? _____ 

 

If yes, please list ______________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________________________________________________________________
_____________________________________________
 

I hereby certify that__________________________________________was examined by me on ____________  20______  and found physically fit to participate in sports in the school year 2018-19.

 

 

Physician’s Signature __________________________________________________Date________________________                                

 

Please Print Name _____________________________________________________________

 

 

ATHLETICS / SPORTS VOLUNTARY ACTIVITIES PARTICIPATION FORM

ACKNOWLEDGMENT AND ASSUMPTION OF POTENTIAL RISK

 

 

I authorize my son/daughter, to participate in the Ukiah Unified School District sponsored activities: (list all sports planning to participate)

                                                                         

                                                                         

                                                                         

                                                                         

 

A.) I understand and acknowledge that these activities, by their very nature, pose the potential risk of serious injury/illness to individuals who participate in such activities.

 

B.) I understand and acknowledge that participation in these activities is completely voluntary and as such is not required by the Ukiah Unified School District for course credit or for completion of graduation requirements.

 

C.) I understand and acknowledge that in order to participate in these activities, my son/daughter and I agree to assume liability and responsibility for any and all potential risks that may be associated with participation in such activities.

 

D.) I understand, acknowledge and agree that the Ukiah Unified School District, its elected or appointed officials, employees, agents or volunteers shall not be liable for any injury/illness suffered by my son/daughter which is incident to and/or associated with preparing for and/or participating in this activity and I voluntarily assume all risk, known or unknown, of injuries, howsoever caused, even if caused in whole or in part by the action, inaction, or negligence, of the released parties to the fullest extent allowed by law.

 

E.) I acknowledge that I have carefully read this VOLUNTARY ACTIVITIES PARTICIPATION FORM and that I understand and agree to its terms.

 

_______________________________________________ ________________________

Parent/Guardian                                                                      Date

 

_______________________________________________ ________________________

Student Signature                                                                   Date

 

A signed VOLUNTARY ACTIVITIES PARTICIPATION FORM and AUTHORIZATION & CONSENT FOR MEDICAL TREATMENT AND HEALTH INSURANCE VERIFICATION FORM must be on file with the Ukiah Unified School District before a student will be allowed to participate in the above extra-curricular activities.

 

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TRANSPORTATION AUTHORIZATION & CONSENT FOR MEDICAL TREATMENT AND HEALTH INSURANCE VERIFICATION

 

TRANSPORTATION AUTHORIZATION:

 

I do hereby give my permission for ___________________________________ to be transported to and from athletic events in UUSD provided transportation OR by UUSD approved parent/guardian drivers when necessary.

 

Signature ________________________________________
 
HEALTH INSURANCE:

 

Pursuant to Education Code 32221, the insurance shall provide the following coverage: At least one thousand five hundred dollars ($1,500) for all medical and hospital expenses.

 

          I have health insurance that meets the requirements under the California Education Code Section 32221.

 

           I do not have health insurance that meets the requirements under the California Education Code Section 32221.

 

Athletic Team/Sport:                _________________________________________

 

Student's Name:                       _________________________________________

 

Insured (Subscribers) Name:  _________________________________________

 

Insurance Company:                _________________________________________

 

Policy/I.D. Number:                 _________________________________________

 

California Education Code 32221.5:

 

Some students may qualify to enroll in no-cost or low-cost local, state, or federally sponsored health insurance programs. Information about these programs may be obtained by calling Medi-Cal at 800-541-5555 or Healthy Families Program at 800-880-5305.

 

AUTHORIZATION & CONSENT FOR MEDICAL TREATMENT

 

In the event of an injury or illness to _______________________________(son/daughter) while participating on the athletic team, I do hereby authorize the Ukiah Unified School District, as agent for the undersigned, to consent to any x-ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under, the general or special supervision of any physician and/or surgeon, whether such diagnosis or treatment is rendered at the office of said physician or at any medical facility.

 

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of the aforesaid agent to give specific consent to any and all such diagnosis, treatment or hospital care which the aforementioned physician in the exercise of his/her best judgment may deem advisable.

 

This authorization shall remain effective through the conclusion of the sport season, including any playoff or championship competition, unless revoked in writing and delivered to said agent.

 

Parent/Guardian Signature: ________________________________ Date: ________________

 

 

 

UKIAH HIGH SCHOOL

CONCUSSION INFORMATION SHEET

 

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 acting uncoordinated

  • 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

 

 

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

 

Athletes with the signs and symptoms of concussion will 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 will 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:

 

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 and for the remainder of the day.”

 

and 

 

 “A student-athlete who has been removed may not return to play until the athlete is evaluated by a licensed heath care provider trained in the evaluation and management of concussion and received written clearance to return to play from that health care provider”. 

 

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

 

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Adapted from the CDC and the 3rd International Conference on Concussion in Sport

Document created 5/20/2010

ATHLETE EJECTION POLICY NOTIFICATION FORM*

(North Coast Section Ejection Policy)

 

Ukiah High School

  

The following rules and minimum penalties are applicable to all players as adopted by the NCS Board of Managers on April 21, 1995. This policy is in effect and will include non-league, league, invitational tournaments/events, post-season; league, section or state playoffs, etc.

 
I. Ejection of a player from a contest for unsportsmanlike or dangerous conduct
Penalty:The player shall be ineligible for the next contest (non-league, league, invitational tournament, postseason {league, section or state} playoff, etc.).
 
II. Illegal participation in the next contest by a player ejected in a previous contest.
Penalty:The contest shall be forfeited and the ineligible player shall be ineligible for the next contest
 
III. Second ejection of a player for unsportsmanlike or dangerous conduct from a contest during one season
Penalty:The player shall be ineligible for the remainder of the season.
 
IV. When one or more players leave the bench to begin or participate in an altercation
Penalty:The player(s) shall be ejected from the contest-in-question and become ineligible for the next contest (non-league, league, invitational tournament, post-season {league, section or state} playoff, etc.)

 

I have read and understand the rules and regulations of the Ejection Policy. Athletes may not participate in any contest until this document is filed with the school.

 

Student's Signature                                                                              (Date)                                                               

 

SPORT(s) ___________________________________________  VAR  JV  FR

                                                                                                            (Circle one)

 

 

 

UKIAH UNIFIED SCHOOL DISTRICT

EXTRACURRICULAR ACTIVITIES RULES / REGULATIONS

 

Students who participate in extracurricular activities serve in the capacity of role models, ambassadors of goodwill, and assume a posture of high expectations as representatives of Ukiah High School, Pomolita Middle School, or Eagle Peak Middle School and are subject to the rules and regulations outlined in this section and Board Policy. Participation in extracurricular activities is defined as athletics, after-school band, after-school drama, and other activities in which the student represents the school.

Violation of the rules and regulations outlined below will result in exclusions from such activities as specified.

Any student who commits a violation of Education Code 48900 and/or 48915 that results in the assignment of a Behavioral Contract or recommendation for expulsion is automatically removed from participation in athletic competition and extracurricular activities for a minimum period of 14 calendar days beginning on the date of the issuance of the Behavioral Contract. All school rules are in effect during school hours, travel to and from school, and during extracurricular activities.

A student who is suspended from school is also suspended from all extracurricular activities during the period of suspension.

Students participating in extracurricular programs are subject to meeting the academic eligibility standards included in the Ukiah Unified School District board policy.

Students participating in athletic programs are subject to all bylaws of the California Interscholastic Federation (CIF), North Coast Section (NCS) and North Bay League (NBL).
A student must be in attendance all day on event days and practice days. Waivers may be given for unusual causes by principal or designee.

Continued or persistent violation of any of these procedures will result in disciplinary action including conferences with parents/guardians, suspension and/or dismissal from an activity. All activity sponsors shall have the final authority for setting criteria for selection, participation, and activity rules other than listed. A copy of these rules will be given to each participant. Any student who is officially dropped from an activity or quits an activity forfeits his/her right for any award.

Ukiah High School

Code of Conduct for Interscholastic Student-Athletes

 

Interscholastic athletic competition should demonstrate high standards of ethics and sportsmanship and promote the development of good character and other important life skills. The highest potential of sports is achieved when participants are committed to pursuing victory with honor according to six core principles: trustworthiness, respect, responsibility, fairness, caring, and good citizenship (the "Six Pillars of Charactersm").

 

This Code applies to all student-athletes involved in interscholastic sports in California. I understand that, in order to participate in high school athletics, I must act in accord with the following. 

 

TRUSTWORTHINESS

  • Trustworthiness — be worthy of trust in all I do.

  • Integrity — live up to high ideals of ethics and sportsmanship and always pursue victory with honor; do what’s right even when it’s unpopular or personally costly.

  • Honesty — live and compete honorably; don’t lie, cheat, steal or engage in any other dishonest or unsportsmanlike conduct.

  • Reliability — fulfill commitments; do what I say I will do; be on time to practices and games.

  • Loyalty — be loyal to my school and team; put the team above personal glory.  

RESPECT

  • Respect — treat all people with respect all the time and require the same of other student-athletes.

  • Class — live and play with class; be a good sport; be gracious in victory and accept defeat with dignity; give fallen opponents help, compliment extraordinary performance, show sincere respect in pre- and post-game rituals.

  • Disrespectful Conduct — don’t engage in disrespectful conduct of any sort including profanity, obscene gestures, offensive remarks of a sexual or racial nature, trash-talking, taunting, boastful celebrations or other actions that demean individuals or the sport.

  • Respect Officials — treat contest officials with respect; don’t complain about or argue with official calls or decisions during or after an athletic event.

RESPONSIBILITY

  • Importance of Education — be a student first and commit to getting the best education I can. Be honest with myself about the likelihood of getting an athletic scholarship or playing on a professional level and remember that many universities will not recruit student-athletes that do not have a serious commitment to their education, the ability to succeed academically or the character to represent their institution honorably.

  • Role-Modeling — Remember, participation in sports is a privilege, not a right and that I am expected to represent my school, coach and teammates with honor, on and off the field. Consistently exhibit good character and conduct yourself as a positive role model.

Suspension or termination of the participation privilege is within the sole discretion of the school administration.

 

  • Self-Control — exercise self-control; don’t fight or show excessive displays of anger or frustration; have the strength to overcome the temptation to retaliate.

  • Healthy Lifestyle — safeguard your health; don’t use any illegal or unhealthy substances including alcohol, tobacco and drugs or engage in any unhealthy techniques to gain, lose or maintain weight.

  • Integrity of the Game — protect the integrity of the game; don’t gamble. Play the game according to the rules.

FAIRNESS

  • Be Fair — live up to high standards of fair play; be open-minded; always be willing to listen and learn.

CARING

  • Concern for Others — demonstrate concern for others; never intentionally injure any player or engage in reckless behavior that might cause injury to myself or others.

  • Teammates — help promote the well being of teammates by positive counseling and encouragement or by reporting any unhealthy or dangerous conduct to coaches.

CITIZENSHIP

  • Play by the Rules maintain a thorough knowledge of and abide by all applicable game and competition rules.

  • Spirit of rules — honor the spirit and the letter of rules; avoid temptations to gain competitive advantage through improper gamesmanship techniques that violate the highest traditions of sportsmanship.

 

I have read and understand the requirements of this Code of Conduct. I understand that I’m expected to perform according to this code and I understand that there may be sanctions or penalties if I do not.

 

_______________________________________               _________

Student-Athlete Signature                                                 Date

 

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HAZING

 

Education Code 32050

As used in this article, “hazing” includes any initiation or pre-initiation into a student organization or any pastime or amusement engaged in with respect to such an organization, which causes, or is likely to cause, bodily danger, physical harm, or personal degradation or disgrace resulting in physical or mental harm, to any student or other person attending any school, community college, college, university, or other educational institution in this state; but the term “hazing” does not include customary athletic events, or other similar contests or competitions.  

 

Education code 32051

No student, or other person in attendance at any public, private, parochial, or military school, community college, college, or other educational institution, shall conspire to engage in hazing, participate in hazing, or commit any act that causes or is likely to cause bodily danger, physical harm, or personal degradation or disgrace resulting in physical or mental harm to any fellow student, or person attending the institution. The violation of this section is a misdemeanor, punishable by a fine of not less than one hundred dollars ($100), nor more than five thousand dollars ($5000), or imprisonment in the county jail for not more than one year, or both.

 

Ukiah Unified School District Board Policy AR 6145.5

Any student who engages in hazing may be subject to discipline including, but not limited to, suspension or expulsion. Hazing means a method of initiation or pre-initiation into a student organization or body, whether or not the organization or body is officially recognized by the district, which is likely to cause serious bodily injury or personal degradation or disgrace resulting in physical or mental harm to a former, current, or prospective student.

 

 
ANABOLIC STEROIDS AND ILLEGAL DRUGS

 

As a condition of membership in the California Interscholastic Federation (CIF) and the governing board of the Ukiah Unified School District Board Policy 5131.63 prohibiting the use of anabolic steroids and illegal drugs has been established. CIF Bylaw 524 requires that all participating students and their parents/guardians sign an agreement.  

 

Before participating in interscholastic athletics, a student athlete and his/her parent/guardian shall sign a statement that the student athlete pledges not to use androgenic/anabolic steroids and dietary supplements banned by the U.S. Anti-Doping Agency and the substance synephrine, unless the student has a written prescription from a licensed health care practitioner to treat a medical condition.

 

Student-athletes must also recognize that under CIF Bylaw 200.D the student may be subject to penalties including not being eligible for participation in CIF sports. We understand that the Ukiah Unified School District policy regarding the use of illegal drugs will be enforced for any violation of these rules. A student who is found to have violated the agreement or this policy shall be restricted from participating in athletics and shall be subject to disciplinary procedures including, but not limited to, suspension or expulsion in accordance with law, Board policy, and administrative regulation.

 

 

                                                                                                                                                                          

Student-athlete signature                                                                                           

 

_________________

Date

 

                                                                                                                                                                          

Parent/Guardian signature                                                                                          

 

_________________

Date

 

 

Athletic Complaint Procedure 2016-17

In the event that there is a concern or complaint (other than that of a criminal nature) with a coach, the following procedure must be followed:

  1. Athlete talks to coach about the concern/complaint. If there is no satisfactory resolution then proceed to step 2.
  2. Parent and athlete talk to coach about concern/complaint. If there is no resolution then proceed to step 3.
  3. Athlete and Parent make an appointment to talk to the Athletic Director. Phone number is (707) 472-5782.  If problem is not resolved then proceed to step 4.
  4. Athlete and Parent make appointment to talk to Principal. If problem not resolved then proceed to step 5.
  5. Athlete and Parent make an appointment to talk to Assistant Superintendent – Human Resources.

Please keep in mind that high school sports have no minimum required playing time. Generally, you can expect the following:

 

Freshman Sports – All members showing up to practice daily will get playing time. While all team members may not play in each and every game, it would be expected that team members will play in the majority of games. Naturally, the better players will get more playing time. Freshman sports are for skills development and preparation for J.V. and Varsity.

 

J.V. Sports- All members practicing daily will get playing time. The better players will play the most, but every effort will be made to allow all players to participate.

 

Varsity Sports- There is no guaranteed playing time. Starters will play the majority of the time in an effort to put the very best team on the field.  

 

 

Parent Signature _________________________________   Date __________________

 

 

Athlete Signature ________________________________   Date __________________

 

 

CODE OF CONDUCT FOR PARENTS/GUARDIANS

"Let the Coaches Coach, Let the Athletes Compete & Let the Officials Officiate"

The role of the parent in the education of a student is vital. The support shown in the home is often manifested in the ability of the student to accept the opportunities presented at school and in life. There is a value system– established in the home, nurtured in the school –that young people are developing. Their involvement in classroom and other activities contributes to that development. Trustworthiness, citizenship, caring, fairness and respect are lifetime values taught through athletics. These are the principles of good sportsmanship and character. With them, the spirit of competition thrives, fueled by honest rivalry, courteous relations and graceful acceptance of the results.

 

As a parent/guardian of a student-athlete at our school, your goals should include:
  1. Promote a healthy lifestyle that does not include the use of performance enhancing drugs or supplements;
  2. Realize that athletics are part of the educational experience, and the benefits of involvement go beyond the final score of a game;
  3. Encourage our students to perform their best, just as we would urge them on with their class work;
  4. Participate in positive cheers that encourage our student-athletes; discourage any cheers that would redirect that focus – including those that taunt and intimidate opponents, their fans and officials;
  5. Learn, understand, and respect the rules of the game, the officials who administer them and their decisions;
  6. Respect the task that our coaches face as teachers; and support them as they strive to educate our youth;
  7. Respect our opponents as student-athletes, and acknowledge them for striving to do their best; and
  8. Develop a sense of dignity and civility under all circumstances. You can have a major influence on your student’s attitude about academics and athletics.

The leadership role you take will help influence your child, and our community, for years to come.

Violation of the above code of conduct may result in one or more of the following consequences: a warning, removal from the venue, suspension from attending home events, or further discipline to be determined by the administration.

"Let the Coaches Coach, Let the Athletes Compete & Let the Officials Officiate"


The majority of fans come to events to watch the athletes. They deserve to do so in an atmosphere that is free from the distraction of others yelling at the coaches, other team’s players or the officials.

Whenever the attention is diverted from the athletes playing the contest we are doing a disservice to our student athletes and ruining the experience of other fans.

As parent/guardian I understand my role and expected conduct at all contests. I understand that the consequences of conduct or behavior that is in violation of these expectations may result in my removal from the venue.


Parent Signature __________________________________________________________________________             Date ________________________

 

Keep Their Heart in the Game
Sudden Cardiac Arrest Information for Athletes & Parents/Guardians

 

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 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 victim to collapse. The malfunction is caused by a congenital or genetic defect in the heart’s structure.

How common is sudden cardiac arrest in the United States?
As the leading cause of death in the U.S., there are more than 300,000 cardiac arrests outside hospitals each year, with nine out of 10 resulting in death. Thousands of sudden cardiac arrests occur among youth each year and it is the #1 killer of student athletes and the leading cause of death on school campuses.
 
Who is at risk for sudden cardiac arrest?
SCA is more likely to occur during exercise or physical activity, so student-athletes are at greater risk. While a heart condition may have no warning signs, studies show that many young people do have symptoms but neglect to tell an adult. This may be because they are embarrassed, they do not want to jeopardize their playing time, they mistakenly think they’re out of shape and need to train harder or they simply ignore the symptoms, assuming they will “just go away.” Additionally, some health history factors increase the risk of SCA.
 
What should you do if your student-athlete is experiencing symptoms?
We need to let student-athletes know that if they experience any SCA-related symptoms it is crucial to alert an adult and get follow-up care as soon as possible with a physician, surgeon, nurse practitioner or physician assistant. If the athlete has any of the SCA risk factors, these should also be discussed with a doctor to determine if  further testing is needed. Wait for your doctor’s feedback before returning to play, and alert your coach, trainer and school nurse about any diagnosed conditions.
 
FAINTING is the #1 SYMPTOM OF A HEART CONDITION
 
Recognize the Signs & Risk Factors
 
Tell Your Coach and Consult Your Doctor if These Conditions are Present in Your Student-Athlete
Potential indicators that SCA may occur Factors That Increase the Risk of SCA
Fainting or seizure, especially during or right after exercise Family history of known heart abnormalities or sudden death before age 50
Fainting repeatedly or with excitement or being startled Specific family history of Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, or Arrhythmogenic Right Ventricular Dysplasia (ARVD)
Excessive shortness of breath during exercise Family members with unexplained fainting, seizures, drowning or near drowning or car accidents
Racing or fluttering heart palpitations or irregular heartbeat Known structural heart abnormality, repaired or unrepaired
Repeated dizziness or lightheaded Use of drugs, such as cocaine, inhalants, “recreational” drugs, excessive energy drinks, diet pills or performance-enhancing supplements
Chest pain or discomfort with exercise  
Excessive, unexpected fatigue during or after exercise  
 
Cardiac Chain of Survival
 
Recognition of Sudden Cardiac Arrest
Recognition of Sudden Cardiac Arrest
Victim is collapsed, unresponsive and not breathing, even if gasping, gurgling, exhibiting breathing noises or seizure-like activity.
Call 9-1-1
Call 9-1-1
Follow emergency dispatcher's instructions. Call any on-site Emergency Responders.
Hands-only CPR
Hands-Only CPR
Begin CPR immediately. Hands only CPR involves fast and continual two-inch chest compressions - about 100 per minute.
Defibrillation
Defibrillation
Immediately retrieve and use an automated external defibrillator to restore the heart to its normal rhythm. Follow step-by-step audio instructions from the AED.
Advanced Care
Advanced Care
Designate a bystander to direct EMS to the victim for quick transfer to the hospital.
 
What is an AED?
 
AED An automated external defibrillator (AED) is the only way to save a sudden cardiac arrest victim. An AED is a portable, user-friendly device that automatically diagnoses potentially life-threatening heart rhythms and delivers an electric shock to restore normal rhythm. Anyone can operate an AED, regardless of training. Simple audio direction instructs the rescuer when to press a button to deliver the shock, while other AEDs provide an automatic shock if a fatal heart rhythm is detected. A rescuer cannot accidentally hurt a victim with an AED - quick action can only help. AEDs are designed to only shock victims whose hearts need to be restored to a healthy rhythm. Check with your school for locations of on-campus AEDs.
 
What are we doing to help protect student athletes?
The State of California passed the Eric Paredes Sudden Cardiac Arrest Prevention Act in 2016 to protect K-12 students participating in school-sponsored athletic activities. New policy adds sudden cardiac arrest (SCA) training to coach certification, and new protocol that empowers coaches to remove from play a student-athlete who exhibits fainting—the number one warning sign of a potential heart condition, and potentially for other conditions if they are believed to be cardiac related. A student-athlete who has been removed from play after displaying signs or symptoms associated with SCA may not return to play until he or she is evaluated and cleared by a licensed health care provider. Parents, guardians, caregivers and adults involved in athletic activities are urged to dialogue with student-athletes about potential warning signs and risk factors and be familiar with the cardiac chain of survival so they are prepared in the event of a cardiac emergency.
 
I have reviewed and understand the symptoms and warning signs of SCA and the new protocol to incorporate SCA prevention strategies into my/my student’s sports program or activity.
 
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STUDENT-ATHLETE SIGNATURE                   PRINT STUDENT-ATHLETE’S NAME                                     DATE
 
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PARENT/GUARDIAN SIGNATURE                   PRINT PARENT/GUARDIAN’S NAME                                  DATE
 
 
 
 
For more information about Sudden Cardiac Arrest visit 
 
 
 
National Federation of High Schools Free 20-Min. Training Video For Coaches, Parents or Anyone Involved in Student Sports Activities
 
Eric Paredes Save A Life Foundation