In an emergency, if the parents cannot be reached, notify:

(We need two names and phone numbers.)

Permission is hereby granted to the attending physician to proceed with any medical or minor surgical treatment, x-ray examination and immunizations for the above-named student.  In the event of an emergency arising out of serious illness, the need for major surgery, or significant accidental injury, I understand that an attempt will be made by the attending physician and coach to contact me in the most expeditious way possible.  If said physician is not able to communicate with me, the treatment necessary for the best interest of the above-named student may be given.

Permission is also granted to the Certified Athletic Trainer or Coach to provide the needed emergency treatment prior to the student’s admission to the medical facilities.

In signing below, you are also giving permission to videotape and take individual/team photographs of the above-named student to be used in the sports publications and newspapers.

The Athlete's Pledge

Individual and team success in sports results from commitment.  The extent to which young athletes are able to make such commitments reflects their maturity as well as their dedication to family, friends, school, and team.  Your coach already has made a similar commitment.  For these reasons, we ask you to read and agree to the following Pledge.

 

As a Student/Athlete I promise:

To be a worthy representative of my teammates and coaches, abiding by school and community expectations and reflecting my team’s values of commitment and hard work.

To maintain my health and fitness levels by following the training rules as prescribed by the Athletic Director and/or Coach.

To reflect the knowledge that a commitment to victory is nothing without the commitment to hard work in practice

To attend every practice unless excused by my coach.

To understand that my future as a responsible adult relates more to my academics than my athletic activities.

To find the time to satisfy my family relationships and responsibilities.

To accept the responsibilities of team membership:  Cooperation, Support of my Teammates, Shared Responsibilities, Positive Interaction, and Mutual Respect.

To reflect good moral standards by expressing my feelings and ideas intelligently and appropriately.

To reflect my belief that true strength involves gentleness and that even the toughest athlete is sensitive to others.

I have read the above statement and promise to live up to them.

To: Student-Athletes and Their Parents

From: Wisconsin Interscholastic Athletic Association and Lac Courte Oreilles Ojibwe School

 

Your high school is a member of the Wisconsin Interscholastic Athletic Association. The following rules and regulations are developed by the member schools of the WIAA and govern the participation by boys and girls in school athletics and in some instances, impact upon sports activities outside the school.

This information bulletin is a summary of the WIAA OFFICIAL HANDBOOK as it pertains to those rules and regulations. Both student-athletes and their parents should have an understanding of these requirements. Equally important is that student-athletes and/or parents talk to their principal or athletic director if they have any question about these regulations. For additional information on Rules of Eligibility see the WIAA Handbook, or visit the WIAA website at www.wiaawi.org.

This bulletin does not discuss specific penalties for all violations. The reason is that penalties vary depending upon the nature of the violation. In addition, schools often have established penalties or periods of ineligibility which are greater than the minimum prescribed by WIAA rules.

There also are exceptions and other permissive provisions in some rules. Student-athletes and their parents should discuss all athletic eligibility related situations with the school principal or athletic director who, if necessary, will get a decision, interpretation, or opinion from the WIAA office.

Student-athletes, as well as parents are asked to read this bulletin, and then sign it and have their signature statement (attached) on file at their school prior to practicing and competing. Reading and signing this form is a condition of participating in interscholastic athletics at WIAA member schools. It does not guarantee a student-athlete’s athletic eligibility nor does it give rise to any contractual rights, direct or indirect, to student-athletes or their parents.

AGE

A student shall be ineligible for interscholastic competition if he/she reaches his/her 19th birthday before August 1 of any given school year.

ACADEMICS

A student-athlete must meet school and DPI requirements defining a full-time student and have received no more than one failing grade (including incompletes) in the most recent school issued grade reporting period. Note: Some member schools adopt code and academic policies and other participation requirements which are more stringent than WIAA minimum requirements. In those instances, the school’s requirements prevail and must be applied as written.

ATTENDANCE

A student-athlete is eligible for interscholastic competition at a member school if he/she is carried on the attendance rolls as a duly enrolled full time Grade 9, 10, 11 or 12 student in that member school. (Subject to satisfying all other eligibility requirements.) Note: A full-time student is further defined as one where the member school is responsible for programming 100% of the student's school day. The student is eligible for like or similar awards, privileges and services as all the other students and meets all obligations and responsibilities as other students, without exception.

A. A student must complete eligibility in the four consecutive years starting with Grade 9, unless there are documented extenuating circumstances and a waiver has been provided.

B. A student is ineligible if he/she has graduated from a school offering studies through Grade 12 or its equivalent. 

C. A student who graduated in May or June retains eligibility for any portion of a spring athletic schedule not completed by the end of the academic year. Mid-year graduation ends athletic eligibility on the last day of attendance. 

D. A student is ineligible if he/she has not been enrolled in some school by the 17th day of a semester or trimester, except upon request of a school in special cases involving sickness, accident, military service, social services assignment, e.g. 

E. A student-athlete may not participate in school sports for more than four different years, and a student-athlete may not participate in the same sport for more than one season each school year.

DETERMINING RESIDENCE FOR PUBLIC SCHOOL STUDENTS

A full-time student, whether an adult or not, is eligible for varsity interscholastic competition only at the school within whose attendance boundaries his/her parents reside, within a given school district, with these additional provisions:

A. Board of Education approved full-time student(s), paying their own tuition and residing full time with parents in their primary residence shall be afforded eligibility. Transfer students are subject to provisions outlined in the transfers section of this document and in the Senior High Handbook. 

B. The residence of a student’s guardians shall determine eligibility in cases where both parents of a student are deceased. The execution of guardianship papers in situations where one or both parents are living does not by itself make a student eligible. 

C. In the event of a divorce or legal separation, whether pending or final, a student’s residence at the beginning of the school year shall determine eligibility, except in situations involving transfer after the fourth consecutive semester following entry into grade 9. For the purpose of this rule, attendance at one day of school and/or attendance at one athletic practice shall determine ‘beginning of school year.’ Under this rule, a student who transfers after the beginning of the school year shall be ineligible at the new school unless approval is granted by the Board of Control in accordance with the transfer and/or waiver provisions as described in the WIAA HS Handbook. 

D. A student whose tuition is paid by the school within whose attendance boundaries parents reside or by the state and is enrolled in a district approved program may be eligible at either school (first priority to school of residence) but (a) may not participate at both schools in the same year and (b) academic ineligibility accompanies student upon transfer. Transfer restrictions may also apply. 

E. A student whose tuition is paid by the school within whose attendance boundaries parents reside or by the state or who is participating full time in a legislated open enrollment option must meet all statutory timeline requirements. This provision extends the opportunity to decline attendance at the new school and continue at his/her school of residence. If the student begins the school year at the new school and then transfers back to school of residence after attending one or more days of school or one or more athletic practices, he/she shall be subject to transfer provisions as outlined in the transfer Section of this document. 

F. A student may continue being eligible in the same school even though parent(s) and/or student move from within that school’s attendance boundaries, provided enrollment is continuous (unbroken in that school). 

G. After a student-athlete has not participated and/or has had their eligibility restricted for one calendar year due to reasons relating to residence and/or transfer, he/she becomes eligible.

H. A student-athlete will not be eligible if his/her attendance at a particular school resulted from undue influence (special consideration because of athletic ability) on the part of any person.

I. A student-athlete who has been declared ineligible at a school for disciplinary reasons, academic reasons or due to another State Association’s provision retains that ineligibility status if he/she transfers to another school.

 J. Except in situations involving transfer after a student’s sixth consecutive semester, a full-time student whose residence in a given district and attendance at a member school does not conform with any of the provisions outlined above shall be eligible for non varsity competition only, for one calendar year, unless a waiver is provided as outlined in the WIAA HS Handbook under Waivers. Transfer students are subject to transfer provisions as outlined in the transfer section of this document and in the Senior High Handbook.

DETERMINING RESIDENCE FOR NONPUBLIC SCHOOL STUDENTS

A full-time student, whether an adult or not, is eligible for varsity interscholastic competition only if the student is residing full time with parents in their primary residence with these additional provisions:

A. In the event of a divorce or legal separation, whether pending or final, a student’s residence at the beginning of the school year shall determine eligibility except in situations involving transfer after a student’s fourth consecutive semester. For the purpose of this rule, attendance at one day of school and/or attendance at one athletic practice shall determine ‘beginning of school year’. Under this rule, a student who transfers after the beginning of the school year shall be ineligible at the new school unless approval is granted by the Board of Control in accordance with the waiver provisions as described in the WIAA HS Handbook under Waivers. Transfer restrictions may also apply. 

B. Residing full time with guardians shall determine eligibility in cases where both parents of a student are deceased. The execution of guardianship papers in situations where one or both parents are living does not by itself make a student eligible. 

C. A student may continue being eligible in the same school even though parent(s) and/or student move from within that school’s traditional attendance area, provided enrollment is continuous (unbroken in that school). 

D. A student who has been in attendance in a nonpublic, self-contained school (i.e. grades K-12 or 7-12) for at least one complete school year prior to reaching Grade 9 and has not broken enrollment during that time is eligible in that nonpublic school upon entering Grade 9. 

E. Except in situations involving mid-year transfer and/or transfer after the fourth consecutive semester students attending member residential schools shall be eligible at the member school provided they reside at the school or reside full time with parents in their primary residence. 

F. Except in situations involving transfer after a student’s sixth consecutive semester, a full-time student attending a nonpublic school but not residing in accordance with any of the provisions outlined above shall be eligible for non varsity competition only, for one calendar year, unless a waiver is provided as outlined in the WIAA HS Handbook under Waivers.

TRANSFERS

A full-time student may be afforded up to eight consecutive semesters of interscholastic eligibility upon entry into Grade 9. Transferring schools at any time may result in restrictions being imposed on eligibility, or in some cases a denial of eligibility. For the purpose of this rule, attendance at one day of school and/or attendance at one athletic practice shall determine ‘beginning of school year.’ These additional provisions relate to transfer cases:

A. A student who transfers from any school into a member school after the sixth consecutive semester following entry into Grade 9 shall be ineligible for competition at any level for one calendar year, but may practice, unless the transfer is made necessary by a total and complete change in residence by parent(s). The calendar year (365 days) will be determined from a student’s first day of attendance at the new school. 

B. Students entering 9th and/or 10th grade at the beginning of the school year and who are within the first four consecutive semesters of high school will be afforded unrestricted eligibility provided all other rules governing student eligibility are met. 

C. Students entering 11th grade are restricted to non varsity opportunities for one calendar year. 

D. Students entering 12th grade as transfer students are ineligible to compete at any level for one calendar year, but may practice. 

E. 9th grade students who transfer after the beginning of the school year and with written consent from both schools directly involved shall be restricted to non varsity opportunities for the remainder of the school year. Restrictions are removed upon entering 10th grade. 

F. 10th or 11th grade students who transfer after the beginning of the school year and with written consent from both schools directly involved shall be restricted to non varsity opportunities for one calendar year (365 days beginning with first day of attendance at the new school). 

G. In the event of divorce or legal separation, whether pending or final, residence at the beginning of the school year shall determine eligibility for students entering 9th and/or 10th grade. In situations involving transfer after the sixth consecutive semester following entry into grade 9 the student is ineligible to compete at any level for one calendar year, but may practice. 

H. District policies with respect to intra-district transfer do not supersede WIAA transfer rules in situations involving post-sixth semester transfers. Intra-district transfers occurring after the sixth consecutive semester following entry into grade 9 result in the student being ineligible for competition at any level for one calendar year (365 days beginning with first day of attendance at the new school), but may practice. 

I. Unless transfer, including an accompanying total and complete change of parents’ residence, is effective at the outset of a semester, a student cannot establish eligibility at his/her new school until the fifth calendar day of such transfer. 

J. If within the first six consecutive semesters following entry into grade 9, a student who transfers more than once in any given school year shall be ineligible for all interscholastic competition for the remainder of that current school year and will be eligible for non varsity opportunities only for the balance of the calendar year. In situations involving transfer after the sixth consecutive semester following entry into grade 9 the student is ineligible to compete at any level for one calendar year, but may practice. 

K. A student may not have eligibility in more than one member school at the same time. A parent or parents who move from a primary residence within one school’s attendance boundaries, to a secondary residence within another school’s attendance boundaries, may be required by the Board of Control to provide evidence of a total and complete move. 

L. A student who transfers from any school, whether or not a member school, with a status of ineligibility for disciplinary reasons, academic reasons and/or as a result of another State Association's regulation or sanction, retains such status at his/her new school for the same period as decreed by the former school. A student who transfers due to expulsion or removal for disciplinary reasons from the previous school is ineligible for the length of the expulsion as determined by the previous school’s Board of Education. Note: A student who does not serve a penalty for violation by leaving the state and competing in another state, will be ineligible for the balance of the suspension upon return to the state. 

M. No eligibility will be granted for a student whose residence within a school’s attendance boundaries, with or without parents, or whose attendance at a school has been the result of undue influence (special consideration due to athletic ability or potential) on the part of any person, whether or not connected with the school.

PHYSICAL EXAMINATION and PARENT'S PERMISSION

A student-athlete, whether an adult or not, must have written permission of parents to participate in school athletics, an emergency information form, and he/she must have a physical examination (signed by a licensed physician, physician’s assistant or advanced practice nurse prescriber) every other school year.

A physical examination taken April 1 and thereafter is valid for the following two school years. Physical examination taken before April 1 is valid only for the remainder of that school year and the following school year.

TRAINING and CONDUCT

A student-athlete must follow his/her school's code of conduct (training rules) on a year-round basis.

A. A student-athlete who violates his/her school's code of conduct during the season of a sport (start of practice to final game) must be suspended from competition for a period of time specified in the code (minimum of one meet) if the violation involves (a) possession and/or use of alcohol, (b) possession and/or use of tobacco, including chewing tobacco and (c) use, possession, buying or selling of controlled substances, street drugs and performance enhancing substances (PES). 

B. The member school will determine minimum penalties for violation of any other provisions of its code of conduct, including out-of-season offenses and for any other unacceptable conduct contrary to the ideals, principles and standards of the school and this Association including but not limited to criminal behavior. 

C. Any student charged and/or convicted of a felony shall, upon the filing of felony charges, become ineligible for all further participation until the student has paid his/her debt to society and the courts consider the sentence served (including probation, community service, etc.). 

D. A student-athlete who violates his/her school's code of conduct at times other than during the actual season of a sport must be disciplined by the school, the nature of such discipline to be determined by the school as indicated in its code of conduct. 

E. A student-athlete who violates any part of the school or WIAA's code of conduct resulting in suspension for any portion of WIAA-sponsored tournament competition must be immediately declared ineligible for the remainder of tournament series in that sport. During the WIAA Tournament, an ineligible athlete may not suit up. 

F. A student-athlete, disqualified from a contest for flagrant or unsportsmanlike conduct, is also suspended from the next competitive event at the same level of competition as the disqualification. 

G. Any player who in the judgment of the official, intentionally spits on, strikes, slaps, kicks, pushes or aggressively physically contacts an official at any time shall be immediately ineligible for competition a minimum of 90 calendar days from the date of the confrontation. In addition, the player is ineligible to compete for the first 25% of the next season in that same sport. 

H. A school must provide an opportunity for the student to be heard prior to a penalty being enforced (except for felony charges). If a student appeals a suspension, according to the school’s appeal procedure, the student is ineligible during the appeal process. 

I. Schools/individuals are prohibited during the regular season and the WIAA tournament series from practicing for regional, sectional, and state tournament preparation at sites and facilities hosting WIAA tournaments.

AMATEUR STATUS

A student-athlete must be an amateur in all recognized sports of this association in order to compete in any WIAA sport.

A. A student-athlete may not accept, receive or direct to another, reimbursement in any form of salary, cash (including gift cards) or share of game or season proceeds for athletic accomplishments, such as being on a winning team, being selected for the school varsity team, or being a place winner in an individual tournament, e.g. 

B. A student-athlete may receive: a medal, cup, trophy or plaque from the sponsoring organization regardless of cost; school mementos valued not more than $200; an award valued not more than $100 retail for participation in an athletic contest in a WIAA recognized sport; and may retain non-school competition apparel worn by the student as part of the team uniform. 

C. A student-athlete may not receive compensation or benefit, directly or indirectly, for the use of name, picture, and/or personal appearance, as an athlete because of ability, potential and/or performance as an athlete. 

D. A student-athlete may not receive free and/or reduced rates on equipment, apparel, camps/clinics/instruction and competitive opportunities that are not identical for any and all interested students. 

E. A student-athlete may not be identified (with or without permission) as an athlete, provide endorsement as an athlete or appear as an athlete in the promotion of a commercial/advertisement and/or profit-making event, item, plan, or service. 

F. A student-athlete may not participate in school athletics or in sports activities outside the school under a name other than his/her own name.

SPORTS ACTIVITIES OUTSIDE OF SCHOOL

Athletes may compete in not more than two non-school competitions with prior school approval during each regular sport season. The contest(s) will not count against the individual maximum for the athlete in that sport. Non School competition will not be allowed during the respective WIAA tournament series in a sport. Violation of this rule results in loss of eligibility for the remainder of the season (including the WIAA tournament series) and forfeiture of the two non-school opportunities.

A. WIAA rules do not prevent athletes from practicing with non school teams or from receiving private skills instruction during the school season. However, they may not participate officially or unofficially (including “banditing”) in more than two non-school competitions or races, including scrimmages against other teams (with school approval). 

(1) This restriction applies to normal nonschool games as well as “gimmicks,” such as reduced numbers competition (3-on-3 basketball, 6 player soccer, e.g.), specific skill contests (punt, pass, and kick, shooting contests, free throws, 3 point, e.g.), fun runs, etc. 

(2) During the season, athletes may participate in a skills contest with approval of the school. Specific skill contests (punt, pass, and kick, shooting contests e.g., free throws, 3 point, drive, chip and putt) isolate separate skills outside of the traditional competition setting. The skill contest may not include physical contact or extreme fatigue as the 

actual sport competition. Fun runs are not considered skills contests. There can be no school coach involvement. All other eligibility rules including amateur status apply. 

(3) A student who was a member of a school team during the previous year may not delay reporting for the school team beyond the school’s official opening day of practice in order to continue nonschool training and/or competition. 

B. During the school year before and/or after the school season of a sport and in the summertime, members of a school’s team may voluntarily assemble with their teammates (without school and/or school coach involvement) at their own discretion. 

C. A student-athlete or his/her parents must pay 100% of the fee for specialized training or instruction such as camps, clinics, and similar programs. 

D. A student-athlete may not be instructed except during the school season of a sport and approved summer contact days by the person who will be his/her coach in that sport in the following school season. All sports except football are exempt from this rule, BUT only (a) during the summer months and (b) if the program involved is not limited to individuals who are likely to be candidates for the school team in that sport in the following season. 

E. A student-athlete must not participate in an all-star game or similar contest except for summertime activities (a) within the same league or program (eg softball game between divisions of same league) or (b) in which a team is selected to represent a league in postseason play (e.g., Babe Ruth league team). Some postseason all-star opportunities may be permitted for 12th graders who have completed high school eligibility in a particular sport. Check with your Athletic Director to be certain. 

F. Schools/individuals are prohibited during the regular season and the WIAA tournament series from practicing for regional, sectional, and state tournament preparation at sites and facilities hosting WIAA tournaments.

USE OF STUDENT IMAGE 

The participation of student-athletes in school and WIAA tournaments may result in the use of student-athlete images in promotion of school and WIAA events. 

In order to facilitate good communication, all questions regarding athletic participation at your school should be addressed to your athletic administrator. 

5/2022

What Is a Concussion? A concussion is a type of head (brain) injury that changes the way the brain  normally works. A concussion is caused by a bump, blow, or jolt to the head. Concussions can also occur  from a blow to the body that causes the head and brain to move rapidly back and forth. Even what seems  to be a mild bump to the head can be serious. Concussions can have a more serious effect on a young,  developing brain and need to be addressed correctly. Consequences of severe brain injury (including  concussion) include problems with thinking, memory, learning, coordination, balance, speech, hearing,  vision, and emotional changes. 

What are the signs and symptoms of a concussion? You cannot see a concussion. Signs and symptoms of  concussion can show up right after an injury or may not appear or be noticed until hours or days after the  injury. It is important to watch for changes in how you as an athlete or your child or teen is acting or  feeling, if symptoms are getting worse, or if you/they just “don’t feel right.” Most concussions occur  without loss of consciousness. 

If the child or teen reports one or more of the symptoms of concussion listed below, or if you notice the  signs or symptoms yourself, seek medical attention right away. Children and teens are among those at  greatest risk for concussion. 

 

These are some SIGNS of concussion (what  others can see in an injured athlete):  

o Dazed or stunned appearance  

o Unsure of score, game, opponent  o Clumsy  

o Answers more slowly than usual  

o Shows behavior or personality changes o Loss of consciousness (even briefly)  o Repeats questions  

o Forgets class schedule or assignments 

Children and teens with a suspected concussion  should NEVER return to sports or recreation  activities on the same day the injury occurred. 

They should delay returning to their activities  until a healthcare provider experienced in  evaluating for concussion says it is OK to return  to play. This means, until permitted, not  returning to: 

o Physical Education (PE) class 

o Sports practices or games 

o Physical activity at recess 

These are some of the more common  SYMPTOMS of concussion (what an injured  athlete feels):  

o Headache 

o Nausea or vomiting 

o Dizzy or unsteady  

o Sensitive to light or noise or blurry vision o Difficulty thinking clearly, concentrating,  or remembering  

o Irritable, sad, or feeling more emotional  than usual  

o Sleeps more or less than usual 

If you or your child or teen has signs or  symptoms of a concussion 

Seek medical attention right away. A healthcare  provider experienced in evaluating for  concussion can determine how serious the  concussion is and when it is safe to return to  normal activities, including physical activity and  school (concentration and learning activities). 

After a concussion, the brain needs time to heal.  Activities may need to be limited while  recovering. This includes exercise and activities  that involve a lot of concentration. 

Information adapted from the Centers for Disease Control and Prevention’s (CDC) Heads Up Safe Brain. 

Stronger Future. For more information view the CDC’s Heads Up to Youth Sports webpages for athletes, parents, and coaches.

Sudden cardiac arrest (SCA), while rare, is the leading cause of death in young athletes while training or  participating in sport competition. Even athletes who appear healthy and have a normal preparticipation  screening may have underlying heart abnormalities that can be life-threatening. A family history of SCA at  younger than age 50 or cardiomyopathy (heart muscle problem) places an athlete at greater risk. Athletes  should inform the healthcare provider performing their physical examination about their family’s heart  history. 

What is Sudden Cardiac Arrest? Cardiac arrest is a condition in which the heart suddenly and  unexpectedly stops beating. If this happens, blood stops flowing to the brain, lungs, and other vital organs. 

Cardiac arrest usually causes death if it is not treated with cardiopulmonary resuscitation (CPR) and an  automated external defibrillator (AED) within minutes. 

Cardiac arrest is not the same as a heart attack. A heart attack occurs if blood flow to part of the heart  muscle is blocked. During a heart attack, the heart usually does not suddenly stop beating. In cardiac arrest  the heart stops beating. 

What warning signs during exercise should  athletes/coaches/parents watch out for?  

o Fainting/blackouts (especially during  exercise)  

o Dizziness  

o Unusual fatigue/weakness  

o Chest pain/tightness with exertion o Shortness of breath  

o Nausea/vomiting  

o Palpitations (heart is beating unusually  fast or skipping beats) 

Stop activity/exercise immediately if you have  any warning signs of Sudden Cardiac  Arrest.  

Speak up and tell a coach and parent/guardian if  you notice problems when exercising. 

If an athlete has any warning signs of SCA while  exercising, they should seek medical attention  and evaluation from a healthcare provider  before returning to a game or practice. 

The risk associated with continuing to participate  in a youth activity after experiencing warning  signs is that the athlete may experience SCA,  which usually causes death if not treated with  CPR and an AED within minutes. 

What are ways to screen for Sudden Cardiac Arrest (SCA)? 

WIAA Pre-Participation Physical Evaluation – the Medical History form includes important heart related  questions and is required every other year. Additional screening using an electrocardiogram and/or an  echocardiogram may be done if there are concerns in the history or physical examination but is not  required (by WIAA). Parents/guardians/athletes should discuss the need for specific cardiac testing with  the medical provider performing the review of family history and physical evaluation or after experiencing  warning signs of sudden cardiac arrest while exercising. The cost of the pre-participation physical and any  follow up examinations or recommended testing including an electrocardiogram is the responsibility of the athlete and their parents/guardians. Not all cases or causes of SCA in young athletes are detected in the  history, examination, or with testing. 

What is an electrocardiogram, its risks, and benefits? An electrocardiogram (ECG) is one of the simplest  and fastest tests used to evaluate the heart. Electrodes (small, plastic patches that stick to the skin) are  placed at specific spots on the chest, arms, and legs. The electrodes are connected to an ECG machine by  wires. The electrical activity of the heart is then measured, interpreted, and printed out. No electricity is  sent into the body. Risks associated with having an ECG are minimal and rare. The benefits include that it is an easy procedure to do, can be performed in many health care offices and it may detect heart  conditions in children with no symptoms. ECGs are good at detecting certain heart conditions that may  increase risk for SCA but may not detect all such conditions. If not performed correctly the information is  not valid and may lead to more (unnecessary) testing and further examinations. ECGs should be  interpreted by experts in reading ECGs in children (i.e., pediatric cardiologists). For more information, view  the Johns Hopkins Medicine - Electrocardiogram website. 

How may a student athlete and parent/guardian request the administration of an electrocardiogram and  a comprehensive physical examination? Athletes participating in WIAA sports are required to have a  physical examination and review of family history every other year. Other youth sports have similar  requirements. Although the cost of these medical examinations is the responsibility of the athlete’s family, many school districts can assist students to find low cost or no cost ways to obtain these examinations.  Athletes should contact their school athletic director if they need assistance in getting an examination. If  an athlete has risk factors, family history of heart disease, or has had warning signs associated with sudden  cardiac arrest while exercising, they should tell the medical provider performing the history and physical  examination and discuss the possible need for an electrocardiogram.

PARENT AGREEMENT 

As a parent/guardian and as an athlete it is important to recognize the signs, symptoms, and behaviors of  concussions and sudden cardiac arrest. By signing this form, you are stating that you have read the Department  of Public Instruction’s (DPI) and the Wisconsin Interscholastic Athletic Association (WIAA) Concussion and  Head Injury information sheet and Sudden Cardiac Arrest Information sheet.  

I understand that it is my responsibility to seek medical treatment if a suspected concussion is reported to me. I  understand that my child cannot return to practice/play until they are evaluated by an appropriate health care  provider and provide written clearance from the health care provider to their coach. 

I understand concussions can have a serious effect on a young, developing brain and need to be addressed  correctly. 

I have read the Sudden Cardiac Arrest information sheet. I understand that my child should stop  activity/exercise immediately if they have any warning signs of sudden cardiac arrest. I understand it is  recommended that if my child has any warning signs of sudden cardiac arrest while exercising, they have a medical  examination before exercising or returning to participation in their sport. I understand that I or my child should  report a family history of heart problems

or warning signs of sudden cardiac arrest to the healthcare provider  doing the medical examination. 

I understand how to request at my cost the administration of an electrocardiogram, in addition to a  comprehensive physical examination required to participate in a youth athletic activity. I understand the  athletic director may be able to assist me.  

ATHLETE AGREEMENT 

As a parent/guardian and as an athlete it is important to recognize the signs, symptoms, and behaviors of  concussions and sudden cardiac arrest. By signing this form, you are stating that you have read the Department  of Public Instruction’s (DPI) and the Wisconsin Interscholastic Athletic Association (WIAA) Concussion and  Head Injury information sheet and Sudden Cardiac Arrest Information sheet.  

Athlete Agreement: 

I understand that I must be removed from practice/play if a concussion is suspected. I understand that I must be  evaluated by an appropriate health care provider and provide to my coach written clearance to participate in  the activity from the health care provider before I may return to practice/play. 

I understand that after a head injury my brain needs time to heal and that it may not heal properly if I return to  practice/play too soon. 

I have read the Sudden Cardiac Arrest Information sheet. I understand that I should stop activity/exercise  immediately if I have any warning signs of sudden cardiac arrest and report the symptoms to my coaches and  my parents/guardians.

Hayward Area Memorial Hospital & Waters Edge

 

Athletic Training Consent Form

Consent to Treat
I understand that Hayward Area Memorial Hospital and Water’s Edge (HAMHWE) contracts with the student-athlete’s school (LCO Schools) to provide training room services. These services are provided by physical therapists (PTs), certified
athletic trainers (ATs), and medical doctors (MDs) who practice according to state statutes, and who assess, treat, and rehabilitate student-athletes’ injuries and conditions.

I give permission for the HAMHWE medical staff to assess, treat, and rehabilitate the student-athlete and refer the student-athlete to a physician or emergency room as appropriate.

Additionally, I authorize HAMHWE share information with any medical personnel directly involved in the student-athlete’s care for the process of making return to play decisions.

Acceptance of Risk and Release of Liability
I understand the risks involved in athletics range from minor to severe. I recognize the possibility that the student-athlete might die, become paralyzed, suffer from brain damage, or other serious, permanent injury as a result of participating in sports. I realize that neither the protective equipment and padding used in the sport, the safety rules and the procedures of the sport, the coaching instruction received, nor the medical care provided to student-athletes on site at LCO Schools will guarantee safety or prevent injuries they might sustain. I further agree to accept these risks as a condition of the student-athlete’s participation in sports. I agree not to hold the medial personnel at HAMHWE responsible for any injury, loss, or damage that occurs to the student-athlete as a result of sports participation.

Additionally, as a condition to the medical personnel assessing, treating, and rehabilitating the student athlete, I hereby release HAMHWE and its affiliates, directors, officers, employees, agents and contractors, and any other organizations
associated with HAMHWE, together with their successors and assigns, from any liability arising from or related to the potential risks associated with the medical personnel assessing, treating, and rehabilitating the student-athlete.

Inquires
I have been given an opportunity to ask any questions about treatment the student-athlete may receive from the medical personnel at HAMHWE and my questions have been answered to my full satisfaction. I have read this form or
have had it read to me if unable to do so. 

Statement of Permission
I fully understand its terms and sign it freely and voluntarily, without inducement. With my signature below, I voluntarily give permission to the appropriate medical staff to assess, treat, and rehabilitate the student-athlete as needed. I
understand that this consent will be in effect as long as the student-athlete is enrolled in the school corporation. I have read and agree to all of the above statements.

Signature of Student-Athlete or Student-Athlete's Legal Guardian (if Student-Athlete is under the age of 18)

WISCONSIN INTERSCHOLASTIC ATHLETIC ASSOCIATION ALTERNATE YEAR ATHLETIC PERMIT CARD

1. I hereby give my permission for the above named student to practice and compete and represent the school in WIAA approved sports.
2. I also attest to the fact that the above named student has had no injury or illness serious enough to warrant a medical evaluation prior to participating this school year.
3. Pursuant to the requirements of the Health Insurance Portability and Accountability Act of 1996 and the regulations promulgated thereunder (collectively known as “HIPAA”), I authorize health care providers of the student named above, including emergency medical personnel and other similarly trained professionals that may be attending an interscholastic event or practice, to disclose/exchange essential medical information regarding the injury and treatment of this student to appropriate school district personnel such as but not limited to: Principal, Athletic Director, Athletic Trainer, Team Physician, Team Coach, Administrative Assistant to the Athletic Director and/or other professional health care providers, for purposes of treatment, emergency care and injury record-keeping.
4. It is recommended that information regarding your child’s allergies and prescribed medication be made available.
PARENT: If there is any question that this student may not be qualified for athletic competition without, at least, a partial re-evaluation, contact your medical advisor before signing card.

 

Signature of Parent

ALL STUDENTS PARTICIPATING IN INTERSCHOLASTIC ATHLETICS MUST HAVE THIS ALTERNATE YEAR CARD ON FILE AT THEIR SCHOOL PRIOR TO PRACTICE OR PARTICIPATION

The following forms must be completed

1. The physical form OR alternate year form (student cannot participate until this is completed)
2. The Emergency Information and Parental Consent form.
3. This signature form indicates that you have read the attached packet of              information and agree to the rules/policies, etc.
4. The Parent and Athlete Concussion/Cardiac Arrest Agreement forms.

 

Please click on following link to view the Athletic Code of Conduct:

 

Athletic Code of Conduct

Parent Signature

Student Signature