ANDERSON SCHOOL DISTRICT Athletic

ANDERSON UNION HIGH SCHOOL DISTRICT

2021-22

Athletic Packet



ANDERSON UNION HIGH SCHOOL

WEST VALLEY HIGH SCHOOL

Students are encouraged to participate in school-sponsored athletics. As a student athlete, you are expected to have a commitment to the sport, the team and the school. You are expected to attend and work hard at practices. You are expected to maintain eligibility and a positive attitude.

To participate in school sponsored sports, students must meet the following criteria:

Pass a Physical Examination Provide Insurance Complete the Enclosed Forms:

Voluntary Participation Liability Waiver

Authorization to Consent Treatment of a Minor

Non-Sponsored Transportation Notice

Acknowledgement & Assumption of Potential Risk (3 parts)

Health Insurance Verification

Concussion Form

Sudden Cardiac Arrest Form

Opioid Fact Sheet

Review the Parent/ Student Handbook

Maintain a 2.0

All completed forms should be returned to the Student Accounts Office.

Please refer to the Parent/Student Handbook under the athletic section for all rules and regulations.

PLEASE CHECK WHICH SCHOOL YOU CURRENTLY ATTEND:

AUHS

WVHS

ANTHS OHS

Information provided will be auto filled throughout this packet as needed in other locations. Please make sure all fields are complete before submitting.

To ensure information is not lost, please DOWNLOAD this packet to your computer before entering any information. Enter the information on the saved copy, then save again once complete. You may return this packet via one of the following methods:

Print at home: Fields may be typed or handwritten Print and sign all pages Return packet to athletic secretary

If you cannot print at home (choose one option): 1. Request electronic signatures o Fill in form electronically and save o Send completed packet to findaway@ o Include parent/guardian AND student email address in request. These must be two separate email addresses. o You will get a request from HelloSign for electronic signatures 2. Send to findaway@ to print o Student may pick up athletic packet from Mrs. Kane and return with all signatures

STUDENT BEHAVIORAL EXPECTATIONS AND PARENT WAIVER AND RELEASE FORM FOR 2021-22 SCHOOL YEAR CIF-Sanctioned Sports

FOR STUDENTS:

I, ___________________________ (Printed Name of Student) agree to abide by the following behavioral expectations, which I have reviewed prior to engaging in the Anderson Union High School District 2021-22 CIF sanctioned sport(s):

1) I will minimize any and all physical contact with other athletes or coaches to the best of my ability during these sessions. I understand that some activities require more physical contact than others and for the duration of those activities I will minimize any and all physical contact when not actively participating in such high-contact activities.

2) I understand and will ensure that equipment is used by a single athlete per training session and no equipment may be shared (e.g. balls, weights, sleds, etc.). I understand that some activities require the sharing of equipment and such activities are the only instances where equipment may be shared.

3) I understand all activities must be outside, except as otherwise indicated by coaches, and I will follow instructions from coaches on available use of restroom facilities.

4) I will maintain a minimum of 6 feet of physical distancing from students and coaches at all times; I understand 10 feet or more is preferred. I understand that some activities will require me to be in close contact with other participants. When close contact is not required for those activities I will abide by the physical distancing requirements.

5) I will wear a face covering when I am not participating in an activity or session. 6) I understand all sessions and activities are optional and I assume the risk for participating

in them. I understand I will not be penalized for non-participation. 7) I understand that if I experience any COVID-19 related symptoms, I will not attend and I

will immediately remove myself from any activity upon experiencing any such symptoms. This includes fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headaches, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, diarrhea, etc. I understand that if I exhibit these symptoms or pretend to exhibit these symptoms, I will be sent home. 8) I will not loiter around campus before or after sessions. I will arrive and depart as close to the session's starting and ending time as possible. 9) I will arrive dressed for activities and understand locker rooms will not be available.

10) I understand members of my immediate household may attend events for the strict purpose of age appropriate supervision. All other observers and participants will be limited to athletes and coaches.

11) I understand I am encouraged to shower at home before and after sessions. 12) I understand that my transport to and from activities is encouraged to be provided by, and

limited to, those in my immediate household. 13) I recognize that I need to bring my own hydration products as shared water bottles are not

allowed. 14) I acknowledge that I may be required to undergo regular and postseason antigen or PCR

testing weekly while participating in high-contact activities. 15) I acknowledge that these expectations may change based on state and county health

guidelines and related protocols. I agree to adhere to these expectations as they may be modified.

Signature _______________________________

Date ________________

________________________________

___________

FOR PARENTS:

As the parent/guardian of the above-named child and on behalf of myself and my child, agents, heirs, and successors, I voluntarily agree to and provide my informed consent to: (1) assume all risks of injury, illness, or death to my child arising out of or resulting from my child's participation in and/or attendance at the above-stated program or activity, such risks to include but are not limited to, injury, illness, or death due to being exposed to or infected by contagious diseases, including COVID-19 (also referred to as 2019 Novel Coronavirus, 2019-nCoV, SARSCov-2, and any other derivatives or mutations); (2) acknowledge that my child's participation in the above-stated program or activity is voluntary and I assume full responsibility for my child's participation (3) waive and release all claims, causes of actions, actions, liabilities, and costs against the Anderson Union High School District (District) and its governing board and members thereof, officers, employees, agents, and volunteers (collectively District Personnel) and hold harmless the District and District Personnel from any claims, causes of actions, actions, liabilities, and costs that may arise out of or result from my child's participation in or attendance at such program or activity; (4) assume all obligations for any medical, financial, and other costs and/or liabilities that be sustained or incurred by my child, myself, or my agents, heirs, and/or successors; and (5) acknowledge this waiver and release is made notwithstanding section 1542 of the California Civil Code which provides: "A general release does not extend to claims which the creditor does not know or suspect to exist in his or her favor at the time of executing the release, which if known by him or her must have materially affected his or her settlement with the debtor" and therefore, I expressly waive the benefits of this provision. The District assumes no responsibility and shall not be liable for any injury, illness, death, liabilities, damages, or costs that my child, myself, my agents, heirs, and/or successors may sustain or incur arising out of or resulting from the aforementioned program or activity.

Printed Name: ______________________

Signature: _______________________________

Date: ________________

ANDERSON UNION HIGH SCHOOL DISTRICT ATHLETIC TRAVEL CARD

AUTHORIZATION TO CONSENT TREATMENT OF A MINOR

Student Name Street Address City, State, Zip Code

MEDICAL INFORMATION

Name of Preferred Physician

List any Drug Allergies

List any Physical Disabilities

INSURANCE INFORMATION (Required)

Insurance Provider (Required) Policy Number (Required)

EMERGENCY CONTACTS

Emergency Phone #

Family Doctor

Has the student ever attended another High School?

Yes

No

If yes, please state which High School:__________________________________________

Please select a preferred hospital:

MercyShasta Regional

St. Elizabeth

List any Regularly Taken Medications List any Medical Problems

Emergency Contact Name

Phone Number

Relationship to Student

Emergency Contact Name

Phone Number

Relationship to Student

AUTHORIZATION

I/We, the undersigned parent/guardian of the above mentioned minor student do hereby authorize the faculty member of the Anderson Union High School District supervising the activity concerned, as agent for the undersigned, to consent to an x-ray, examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under general or special supervision of any physician and surgeon licensed under the provision of the Medical Practice Act on the medical staff of any licensed hospital whether such diagnosis or treatment is rendered at the office of said physician or at the said hospital.

It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care required but is given to provide authority and power on the part of our 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 best judgment may deem advisable.

This authorization is given pursuant to the provision of Section 25.8 of the Civil Code of California. This authorization shall remain effective until the end of the school year in which it was signed.

Parent/Guardian Signature

Date

AUTHORIZATION & CONSENT FOR MEDICAL TREATMENT AND HEALTH INSURANCE VERIFICATION

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.

Athletic Team/Sport:

Student's Name:

Insured (Subscribers) Name:

Insurance Company (Required):

Policy/I.D. Number (Required):

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 888-599-7056.

AUTHORIZATION & CONSENT FOR MEDICAL TREATMENT

In the event of an injury or illness to

while participating on the athletic team, I do hereby authorize

the Anderson Union High 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

Student Signature

Date

?Keenan & Associates for Nor Cal ReLiEF 2010 & 2016 Modified by NCSIG for its Members 2017

Anderson Union High School District

1469 Ferry Street, Anderson, CA 96007 530/378-0568 Victor Hopper, Superintendent

Every Student Will Learn Every Graduate Will Be College and Career Ready

NON-SPONSORED TRANSPORTATION NOTICE

The undersigned hereby acknowledges and understands that the Anderson Union High School District does NOT provide transportation to the school-sponsored activities inside the Golden Triangle and that it is the responsibility of the undersigned to arrange for transportation. Student-Athletes may not drive other students to and/or from athletic events.

As parent/legal guardian, I hereby authorize and give permission for my child, ___________________ , to drive himself/herself or to ride as a passenger in a vehicle driven by another parent.

The undersigned acknowledges and understands that the driver is not driving on behalf of or as an agent of the Anderson Union High School District. Further, the undersigned understands that the Anderson Union High School District has not verified the driving record of the driver or the mechanical condition of the vehicle.

IT IS FULLY UNDERSTOOD THAT THE ANDERSON UNION HIGH SCHOOL DISTRICT IS IN NO WAY RESPONSIBLE, NOR DOES THE ANDERSON UNION HIGH SCHOOL DISTRICT ASSUME LIABILITY, FOR ANY INJURIES OR LOSSES RESULTING FROM THIS NONDISTRICT SPONSORED TRANSPORTATION. ALTHOUGH THE ANDERSON UNION HIGH SCHOOL DISTRICT MAY ASSIST IN COORDINATING THE TRANSPORTATION AND/OR RECOMMEND TRAVEL TIME, ROUTES, OR CARAVANNING TO OR FROM THIS EVENT, I FULLY UNDERSTAND THAT SUCH RECOMMENDATIONS ARE NOT MANDATORY.

__________________________________________ Parent/Guardian's Signature

____________________________ Date

__________________________________________ Student's Signature

____________________________ Date

Outside the Golden Triangle: Any exceptions to transportation guidelines will be made when the parent contacts the principal or designee in advance (by note or call) of the activity. In these cases the student-athlete will be released by the person in charge, upon direct authorization by the principal or designee.

Red Bluff

ANDERSON UNION HIGH SCHOOL DISTRICT

ACKNOWLEDGEMENT OF ATHLETIC POLICIES

The undersigned fully understands that all extracurricular activity participants are governed by the policies, regulations, and standards contained within the Parent/Student Handbook. The Parent/Student Handbook may be viewed on your Aeries Portal account or obtained in the Counseling Office.

I have read and understand the following policies: Notice of Risk to Students and Parents High School Athletic Code Student Athlete Code of Conduct Student Athlete Tobacco, Alcohol, & Drug Policy Ethics in Sports NCAA Initial Eligibility Clearinghouse Transportation Rules & Regulations Authorization to Use School Transportation Use of Steroids

Parent Initials

Student Initials

___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________ ___________________________ _________________________

I understand fully that my performance as a participant and the reputation of my school are dependent, in part, on my conduct as an individual. I hereby agree to accept and abide by the standards, rules, and regulations set forth by the Anderson Union High School District Board of Trustees and the sponsors for the activity in which I participate.

I also authorize the Anderson Union High School District to conduct a test on a urine specimen which I provide to test for drugs and/or alcohol use. I also authorize the release of information concerning the results of such a test to the Anderson Union High School District and to the parents and/or guardians of the student.

This shall be deemed a consent pursuant to the Family Education Right to Privacy Act for the release of the above information to the parties named above. I also authorize the use of names and photographs to be published on the District athletic web site.

_____________________________________________________________________________________________________________________

Student Name (please print)

______________________________________________________________________________

Student Signature

______________________________

Date

______________________________________________________________________________________ Parent/Guardian Signature

______________________________ Date

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