Sports Participation Packet

Part 1- Code of Conduct
Your son/daughter has requested the privilege of taking part in our athletic program. Before he/she may take part, it is necessary for us to have your consent by completing the form below.

I will be happy to try to answer any questions you might have regarding the PRHS Athletic Program. You may call me at the high school, (201) 573-6000 ext. 5610, or write me in care of the school.
Sports
All seasons are available. Please make sure you select the sports in the season you want to participate in. Failure to select a sport will not allow you to tryout for a team.
Fall Sports
- Cheerleading
- Cross Country (B)
- Cross Country (G)
- Football
- Soccer (B)
- Soccer (G)
- Tennis (G)
- Volleyball
- Weightlifting
Winter Sports
- Basketball (B)
- Basketball (G)
- Bowling (B)
- Bowling (G)
- Competition Cheer
- Ice Hockey
- Indoor Track (B)
- Indoor Track (G)
- Swimming (B)
- Swimming (G)
- Wrestling
Spring Sports
- Baseball
- Golf
- Lacrosse (B)
- Lacrosse (G)
- Softball
- Tennis (B)
- Track (B)
- Track (G)
Student-Athlete's Name*
First Last
Student Email*
Date of Birth*
Grade*
Student-Athlete Phone*
Parent/Guardian's Name*
First Last
Parent Email*
Address*
Street Address City State ZIP Code
Phone*
Date*
Code of Conduct*
- Please click confirming your have read the Park Ridge Code of Conduct.
  
  We have read and understand the Athletic Code of Conduct form of Park Ridge High School.
  
  We also understand that participation in interscholastic athletics involves an element of danger and risk of personal injury, and we have chosen to participate with that awareness in mind.
Parent/Student Handbook*
- Please click confirming your have read the Park Ridge Parent/Student Handbook
  
  We have read and understand the Parent/Student handbook form of Park Ridge High School.
Digital Signature*
- By clicking this box, I attest to my understanding and concurrence with the information presented on this page.

Part 2- NJSIAA Steroid Testing Policy Consent To Random Testing
In Executive Order 72, issued December 20, 2005, Governor Richard Codey directed the New Jersey Department of Education to work in conjunction with the New Jersey State Interscholastic Athletic Association (NJSIAA) to develop and implement a program of random testing for steroids, of teams and individuals qualifying for championship games.

Beginning in the Fall, 2006 sports season, any student-athlete who possesses, distributes, ingests or otherwise uses any of the banned substances on the attached page, without written prescription by a fully-licensed physician, as recognized by the American Medical Association, to treat a medical condition, violates the NJSIAA’s sportsmanship rule, and is subject to NJSIAA penalties, including ineligibility from competition.

Athletes may submit supplements and medications to Drug Free Sport AXIS to receive information regarding banned substances or safety issues. Athletes or parents may login to the NJSIAA account at www.dfsaxis.com using the password “njsports”.

The NJSIAA will test certain randomly selected individuals and teams that qualify for a state championship tournament or state championship competition for banned substances. The results of all tests shall be considered confidential and shall only be disclosed to the student, his or her parents, and his or her school. No student may participate in NJSIAA competition unless the student and the student’s parent/guardian consent to random testing.

By signing below, we consent to random testing in accordance with the NJSIAA steroid testing policy and Anabolic Steroid Testing Protocols. We understand that if the student or the student’s team qualifies for a state championship tournament or state championship competition, the student may be subject to testing for banned substances.
Please click both confirming your have read the NJSIAA Steroid Testing Policy Consent To Random Testing (above) and the List of Banned Substances*
- I have read the NJSIAA Steroid Testing Policy
- I have read the List of Banned Substances
Digital Signature*
- By clicking this box, both student/athlete and parent/guardian attest to our understanding and concurrence with the information presented on this page.

Part 3- NJSIAA Concussion Policy Acknowledgement Form
NJSIAA has mandated that the parents/guardians of a student-athlete who participates in interscholastic athletics receive on an annual basis, per year the student athlete participates, a concussion information sheet. The student-athlete and their parents/guardians shall sign acknowledging that they have received a copy of the informational sheet, in addition to the already required pre-participation examination forms. Failure to comply with this provision shall preclude the student-athlete from participating in athletics related to the desired sport.

For up-to-date information on concussions, you can go to:
Concussions In Youth Sports
NFHS Learn
Please click both confirming your have read the NJSIAA Parent/Guardian Concussion Policy Acknowledgment Form.*
- I have read the NJSIAA Parent/Guardian Concussion Policy Acknowledgment Form
Digital Signature*
- By clicking this box, both student/athlete and parent/guardian attest to our understanding and concurrence with the information presented on this page.

Part 4- IMPACT Permission
Park Ridge High School utilizes an innovative concussion management program for our student athletes. The program is called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing) and involves an online, computerized exam that the athlete takes prior to the athletic season. All student athletes are required to take the baseline test on a home computer or school computer.

If the athlete is believed to have suffered a concussion during athletic participation, the exam is taken again and the data is compared to the baseline test. This information is then used as a tool to assist the athletic trainer and treating physicians in determining the extent of the injury, monitoring recovery, and in making safe return to play decisions. If an injury of this nature occurs, we will be in contact with you. Post-concussion test will be taken under our supervision at school.

Founded by the University of Pittsburgh Medical Center’s Sports Concussion program, this software system is fast becoming the “Gold Standard” in recognizing and managing head injuries. The program is used by countless colleges and high schools across the country, as well as in professional and Olympic sports such as: the NFL, NHL, and the US Soccer teams. General information about the test can be found at: www.impacttest.com.

The exam takes about 25-30 minutes and is non-invasive. The program is basically set-up in a (video game) type format. It tracks neuro-cognitive information such as memory, reaction time, brain processing speed, and concentration.

One of the reasons concussions are so dangerous is a condition called Second Impact Syndrome. If an athlete sustains a second concussion before completely recovering from the first, the results can be deadly. At Park Ridge, we understand the competitive nature of sports, but we always hold the athlete’s health and safety as our top priority.

The baseline test is not intended to identify a present concussion. Students who have suffered a recent concussion or have not recovered from a concussion should not take the ImPACT baseline test. Instead please notify the Athletic Trainer immediately for an injury evaluation. In addition, athletes who are experiencing fatigue, physical illness, or an injury should postpone the test until feeling better.

Please sign and return the bottom portion of this form indicating that your son/daughter has taken the test. If you do not have access to a home computer, please contact our Athletic Trainer at 201-573-6000 ext. 5602.
Impact Attestation*
- I have read and understood the above information and give permission for my son/daughter to participate in the ImPACT Concussion Management Program. I also agree to ensure a valid test by following the guidelines provided by ImPACT

Part 5- Sudden Cardiac Death In Young Athletes
Governor Christie signed the Scholastic Student-Athlete Safety Act (P.L. 2013, c.71) on June 27, 2013, effective November 1, 2013. The intent of the Act is to establish measures to ensure the health of student athletes in public and nonpublic schools including:

• Use of a “Preparticipation Physical Evaluation” (PPE) form developed jointly by designated organizations;
• Development of a professional development module to increase the assessment skills of those health care practitioners who perform the student athlete physical examinations;
• Certification by the health care practitioner, who completes the PPE, and the school physician who reviews and approves the PPE that they have completed the module;
• Inclusion of a statement of assurance in the contract between the school district and the school physician that the school physician has completed the module; and
• Distribution of a pamphlet about sudden cardiac arrest provided by the New Jersey Department of Education (NJDOE) to parents of student athletes and receipt of a written certification from parents that they received and reviewed the pamphlet
Please click confirming your have read the Sudden Cardiac Death In Young Athletes Phamphlet.*
- I have read the Sudden Cardiac Death In Young Athletes Phamphlet
Opioid Use and Misuse Fact Sheet
In accordance with N.J.S.A. 18A:40-41.10, public school districts, approved private schools for students with disabilities, and nonpublic schools participating in an interscholastic sports program must distribute the Opioid Use and Misuse Educational Fact Sheet to all student-athletes and cheerleaders. In addition, schools and districts must obtain a signed acknowledgement of receipt of the fact sheet from each student-athlete and cheerleader, and for students under age 18, the parent or guardian must also sign.

In accordance with the law, the fact sheet must be distributed and a sign-off sheet completed and collected for each student-athlete or cheerleader prior to the first official practice session of the spring 2018 athletic season (March 2, as designated by the New Jersey State Interscholastic Athletic Association), and annually thereafter prior to the student’s first official practice of the school year.
Please click the box below acknowledging that you received and reviewed the Educational Fact Sheet on the Use and Misuse of Opioid Drugs.*
- I have read and reviewed the Educational Fact Sheet on the Use and Misuse of Opioid Drugs
NJSIAA OPIOID POLICY ACKNOWLEDGEMENT
Acting to address the increased risk of opioid abuse among high school athletes, the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (NJCARES) and the New Jersey State Interscholastic Athletic Association (NJSIAA) announced a new partnership to educate student athletes and their parents/guardians on addiction risks associated with sports injuries and opioid use.

This educational initiative, spearheaded by Attorney General Gurbir Grewal and approved by the Executive Committee of the NJSIAA, is a collaborative effort to use video programming to raise awareness among high school athletes that they face a higher risk of becoming addicted to prescription pain medication than their fellow students who do not play sports.

Please review the Opioid video by clicking on the following link: Opioid Video
Please click the box below acknowledging that you viewed the Opioid Video.*
- We have watched the Opioid Video
Sports Related Eye Injuries
Eye injuries are the leading cause of preventable blindness and visual impairment in children, and most injuries occurring in school-aged children are sports-related. The fact sheet, developed by the New Jersey Department of Education, includes critical information to promote the prevention of eye injuries as well as recommendations for the appropriate management of eye injuries that may occur. Each school district and nonpublic school is required to distribute the educational fact sheet annually to parents or guardians of the students, pursuant to N.J.S.A. 18A:40-41.9(b), in order to reduce the needless loss of sight that can occur during sports activities. Below is a fact sheet that needs to be reviewed prior to participating in a sport.
Please click the box below acknowledging that you received and reviewed the Sports Related Eye Injuries document.*
- I have read and reviewed the Sports Related Eye Injuries document

Part 6- Emergency Information Card
Please complete the required emergency information card. In order to participate with an athletic team, each student-athlete must submit this completed form before the first practice.
Athlete's Name*
First Last
Medical Information
Allergies*
- Yes
- No
List Allergies
Asthma*
- Yes
- No
Medications:*
Relevant Past Medical History*
PRIMARY EMERGENCY CONTACT
Name*
Relation:*
Home Phone (with area code)*
Cell Phone (with area code)*
SECONDARY EMERGENCY CONTACT
Name*
Relation:*
Home Phone (with area code)*
Cell Phone (with area code)*
PHYSICIAN INFORMATION
Name*
Phone (with area code)*
Physician Address*
Street Address City State ZIP Code

STUDENT/ATHLETIC ACCIDENT INSURANCE
Please click confirming your have read the Student/Athletic Accident Insurance for the current school year.*
- I have read the Student/Athletic Accident Insurance

Declaration
I declare that my signature below signifies my understanding and concurrence with the information completed in the Sports Permission Packet, which includes:
- Code of Conduct
- Steroid Consent Form
- Concussion Policy
- Impact Permission
- Sudden Cardiac Death In Young Athletes
- Opioid Use and Misuse Face Sheet
- Sports Related Eye Injuries document
- Emergency Information Card
DECLARATION*
- I declare to my understanding and concurrence with the information completed in the Sports Persmission Packet, which includes: Code of Conduct, Steroid Testing Policy, Concussion Policy, Impact Permission, Sudden Cardiac Death In Young Athletes, Opioid Use and Misuse Face Sheet and Emergency Information Card.
Student/Athlete's Name*
First Last
Date*
Student/Athlete Signature*
Parent/Guardian Name*
First Last
Date*
Parent/Guardian Signature*

Step 1 of 8

Part 1- Code of Conduct

Sports

Part 2- NJSIAA Steroid Testing Policy Consent To Random Testing

Part 3- NJSIAA Concussion Policy Acknowledgement Form

Part 4- IMPACT Permission

Part 5- Sudden Cardiac Death In Young Athletes

Opioid Use and Misuse Fact Sheet

NJSIAA OPIOID POLICY ACKNOWLEDGEMENT

Sports Related Eye Injuries

Part 6- Emergency Information Card

Medical Information

PRIMARY EMERGENCY CONTACT

SECONDARY EMERGENCY CONTACT

PHYSICIAN INFORMATION

STUDENT/ATHLETIC ACCIDENT INSURANCE

Declaration