JSerra Athletic Eligibility Packet 2016-2017

 
You may check more than one.​​​​​
 

Authorization to Treat and Liability Release

The undersigned Parent or Legal Guardian of the athlete listed above authorizes any representative of JSerra Catholic High School, as agents for the undersigned, to consent to any x-ray, examination, anesthetic, medical or surgical diagnosis, or treatment and hospital care that is deemed advisable by, and is to be rendered under, the general or special supervision of any physician and surgeon licensed under the provisions of the Medical Practice Act on the medical staff of any hospital, whether such diagnosis or treatment is rendered at the office of said physician or at said hospital. It is understood that effort shall be made to contact the undersigned prior to rendering treatment to the student, but that treatment will not be withheld if the undersigned cannot be reached. The undersigned understand there are risks associated with school activities, and individually and on behalf of the above-named student, hereby expressly assume all such risks. Furthermore, for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, the undersigned, individually and on behalf of the above-named student, agrees to indemnify and knowingly and voluntarily releases, acquits, and discharges JSerra, and each of its officers, directors, employees, agents, volunteers, and representatives, of and from any and all liability, losses (known or unknown), damages, costs, claims, demands, causes of action and/or expenses, including attorneys' fees, relating to or arising from such participation, including but not limited to personal injury, property damage or wrongful death, unless such claims result from the willful misconduct or gross negligence on the part of the school.

Please type your full name in the field below to indicate your authorization.​​​​​
 

Pre-participation Physical Evaluation


Each student-athlete is required to complete the Pre-Participation Physical Evaluation Form. This form must be downloaded, printed, completed, and returned to Kayla Gradillas in the Athletics Department or via email at kgradillas@jserra.org. This form must be completed by an MD, DO, NP, or PA-C.

 

Medical Insurance Information

 

Emergency Contact Information

List in order of priority:

 

Health Information

Please list any physical handicap or limitation which hinders maximum participation in academic or athletic activities, including field trips:​. Enter "N/A" if none.​
Check all that apply:​​
 

Confidentiality Agreement

The JSerra Catholic High School Health Office is requesting signed permission to share this information with the student’s teachers, administrative staff, athletic personnel, and/or any other school staff having contact with the student. The information will be provided on a "need to know" basis only. This request is being made solely for the purpose of ensuring the health, wellness and safety of your child while on campus or during school related activities.

Please type your full name in the field below to indicate your acknowledgment of the above Confidentiality Agreement.​​​​​​​

Continued . . .

Concussion Information

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 displays incoordination
  • 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 should 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 should 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: it's 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/.

Please type your full name in the field below to indicate your acknowledgment of the above Concussion Information.​​​​​​​​
Please type your full name in the field below to indicate your acknowledgment of the above Concussion Information.​​​​​​​​​

Continued . . .

Sportsmanship Code of Ethics

JSerra is committed to providing a sportsmanlike environment for students, coaches, and spectators. A good sport can take a loss or defeat without complaint and/or victory without gloating. He/she treats opponents with fairness, courtesy, and respect. The Code of Ethics and consequences for inappropriate behavior apply to any participant and/or spectator at any and all athletic competition.

Code of Ethics

  • Emphasize the proper ideals of sportsmanship, ethical conduct.
  • Eliminate all possibilities that tend to destroy the best values of the game.
  • Show cordial courtesy to visiting teams, officials, and spectators.
  • Respect the integrity and judgments of sports officials.
  • Recognize that the purpose of athletics is to promote the physical, mental, moral, social, and emotional well-being of the individual student-athletes.

Behavior Inappropriate at Athletic Events

  • Berating opponent's school or mascot.
  • Berating and/or harassing opposing student-athletes.
  • Obscene, inappropriate, unsportsmanlike, and/or negative cheers or gestures toward the student-athletes and/or spectators from the opposing school and/or sports officials/referees.
  • Obscene, inappropriate, unsportsmanlike, and/or negative signs or those that include the name of the opposing school or names of students of the opposing school.
  • No mechanical noisemakers or cheering devices (CIF rule).
  • Any behavior inconsistent with the JSerra Philosophy and Mission Statement, Code of Christian Conduct, Code for Student Behavior, and/or the Sportsmanship Code of Conduct.

Student-Athlete Documentation Requirements: All student-athletes, before participation begins, must have all the proper documentation complete. This includes, but is not limited to:

  1. JSerra Catholic High School registration and enrollment documents
  2. All student-athlete participation fees; must be current
  3. Attain transfer approvals according to CIF guidelines (transfer students only)
  4. All contents of the online Athletic Eligibility Packet

Parents: Success in athletics at JSerra is ultimately determined by how well our athletic community, which includes parents, coaches, athletes, and fans, adhere to the "Six Pillars of Character". This includes, but is not limited to, parent conduct at all practices, games, banquets and any JSerra Catholic High School event. Any and all actions contrary to the pillars would be considered acting in a fashion "unbecoming of a Lion" and subject to an appropriate response.

The electronic signatures below that all terms set forth and in all the supporting documents online at www.jserra.org/athletics have been read and are agreed to including, but not limited to, sport fees and student-athlete documentation.
This form must be signed and submitted for your son/daughter to be eligible to participate in any interscholastic program related to JSerra Catholic High School.

Please type your full name in the field below to indicate your acknowledgment of the above Sportsmanship Code of Ethics.​​​​​​​​​
Please type your full name in the field below to indicate your acknowledgment of the above Sportsmanship Code of Ethics.​​​

Continued . . .

Eligibility, Transportation, and Liability Form

Student Transportation Consent and Release

There are times when practices, competitions, and other school activities will be held off campus. Although JSerra Catholic High School ("JSerra") provides transportation to such activities, we recognize that students on occasion may benefit from the use of other transportation options. General consent allows for any licensed driver over the age of 18 to take the student-athlete below to any school related activity.

Please type "N/A" if you do give your general consent.​

I understand that JSerra Catholic High School faculty and staff can only supervise activity participants when they travel to and from activities in school vehicles. Furthermore, for good consideration, the receipt and adequacy of which are hereby acknowledged, I, individually and on behalf of the above-named student, agree to indemnify and knowingly and voluntarily release, acquit, and discharge JSerra, and each of its officers, directors, employees, agents, volunteers (including volunteer drivers), and representatives, of and from any and all liability, losses (known or unknown), damages, costs, claims, demands, causes of action and/or expenses, including attorneys' fees, relating to or arising from any personal injury, property damage, loss of life or other damage suffered by the above-named student or any other person while travelling to or from any school activity via transportation other than a school vehicle.

Please type your full name in the field below to indicate your acknowledgment of the above Student Transportation Consent and Release.​​
Please type your full name in the field below to indicate your acknowledgment of the above Student Transportation Consent and Release.​​ Type "N/A" if you do not give your consent and have indicated other transportation options in the field above.​​

Continued . . .

Athletic Pavilion and Athletic Fields Rules & Regulations

Athletes are not allowed to engage in any activities without supervision. this includes but is not limited to activities in the weight room, the athletic fields, tennis courts, volleyball courts, basketball courts, etc.

Athletes are expected to change in the locker rooms.

Athletes are not allowed to change in the pavilion restrooms, parking lot, pool deck, fields or any other area that is not designated for changing.

Athletes are not allowed in the lions den (coaches offices) unless accompanied by a coach or administrator.

Athletes are not allowed in the snack bar, training room, weight room or sports lab without authorized supervision.

Athletes must cross the street using the bridge. Athletes are not allowed to walk or drive across the street during the course of the regular school day.

There is no loitering in the jserra pavilion, athletic fields and or locker rooms. if a student is not participating in an organized practice, scheduled contest, or supporting a scheduled competition, a student may be asked to vacate the premisses.

All athletes are discouraged from bringing money, cell phones, laptops, or any other items of value to the JSerra pavilion, locker rooms, or athletic fields.

Any lost, stolen or misplaced items are not the responsibility of JSerra Catholic High School, JSerra officers, directors, faculty, staff, volunteers, and or any other representatives.

Any athletes that are found to be responsible for stolen or damaged property will be held liable for the cost of damages and face punishment up to but not limited to expulsion from JSerra Catholic High School.

I understand that JSerra Catholic High School faculty and staff will enforce these rules and regulations if and when necessary. Furthermore, for good and valuable consideration, the receipt and adequacy of which are hereby acknowledged, I, individually and on behalf of the above-named student, agree to indemnify and knowingly and voluntarily release, acquit, and discharge JSerra, and each of its officers, directors, employees, agents, volunteers, and representatives, of and from any and all liability, losses (known or unknown), damages, costs, claims, demands, causes of action and/or expenses, including attorneys' fees, relating to or arising from the violation of any of the rules and regulations listed above.

Please type your full name in the field below to indicate your acknowledgment of the above Athletic Pavilion and Athletic Fields Rules & Regulations.​​
Please type your full name in the field below to indicate your acknowledgment of the above Athletic Pavilion and Athletic Fields Rules & Regulations.​​

Continued . . .

CIF Code of Ethics – Athletes

Athletics is an integral part of the school's total educational program. All school activities, curricular and extra-curricular, in the classroom and on the playing field, must be congruent with the school's stated goals and objectives established for the intellectual, physical, social and moral development of its students. It is within this context that the following Code of Ethics is presented.

As an athlete, I understand that it is my responsibility to:

  1. Place academic achievement as the highest priority.
  2. Show respect for teammates, opponents, officials and coaches.
  3. Respect the integrity and judgment of game officials.
  4. Exhibit fair play, sportsmanship and proper conduct on and off the playing field.
  5. Maintain a high level of safety awareness.
  6. Refrain from the use of profanity, vulgarity and other offensive language and gestures.
  7. Adhere to the established rules and standards of the game to be played.
  8. Respect all equipment and use it safely and appropriately.
  9. Refrain from the use of alcohol, tobacco, illegal and non-prescriptive drugs, anabolic steroids or any substance to increase physical development or performance that is not approved by the United States Food and Drug Administration, Surgeon General of the United States or American Medical Association.
  10. Know and follow all state, section and school athletic rules and regulations as they pertain to eligibility and sports participation.
  11. Win with character, lose with dignity.

As a condition of membership in the CIF, all schools shall adopt policies prohibiting the use and abuse of androgenic/anabolic steroids. All member schools shall have participating students and their parents, legal guardian/caregiver agree that the athlete will not use steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition (Article 523).

By electronically signing below, both the participating student athlete and the parents, legal guardian/caregiver hereby agree that the student shall not use androgenic/anabolic steroids without the written prescription of a fully licensed physician (as recognized by the AMA) to treat a medical condition. We recognize that under CIF Bylaw 202, there could be penalties for false or fraudulent information.

We also understand that JSerra Catholic High School's policy regarding the use of illegal drugs will be enforced for any violations of these rules.

Please type your full name in the field below to indicate your acknowledgment of the above Code of Ethics.​​​
Please type your full name in the field below to indicate your acknowledgment of the above Code of Ethics.​​

JSerra Catholic High School

26351 Junipero Serra Road
San Juan Capistrano, CA 92675
Phone: 949.493.9307 | Fax: 949.493.9308
Email: info@jserra.org

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