ATHLETIC PACKET

Dear Parents/Guardians:

Your son/daughter has indicated an interest in the athletic program at Perris Union High School District. Before an athlete can tryout, practice or participate in Athletics in the Perris Union High School District, he/she must meet certain requirements and complete this packet which includes the following forms located in the back of this packet.

1. Impact2. Athletic Release of Liability3. Student Athletic Media Release Authorization4. Code Of Ethics5. CIF Eligibility

To be a member of a PUHSD athletic team is a privilege and an honor. We expect all players to conduct themselves in a manner that will make fellow players, parents, and coaches proud of them. With your interest and support, we will continue to provide the best athletic program possible.

If you have any questions, please call the Athletic Director at your school site:

Heritage High School Paloma Valley High School Perris High School

(951) 940-5447 (951) 672-6030 (951) 657-2171

Scott Moore Michael Pfeiffer Ken Cohen Athletic Director/Dean Athletic Director/Dean Athletic Director/Dean

Pinacate Middle School California Military Institute

Rashiid Burgo, Athletic Director Brandon Jones, Athletic Director

(951) 443-2731 (951) 943-6447

Athletic Participation Expectations

Athletic Code: The CIF Blue Book Rules and Regulations, as well as this District’s Athletic Code will

govern athletic participation. Athletes will be directly responsible to the head coach of that sport and their assistants. It is assumed that the athlete’s participation in a sport is a privilege, and because of this, he or she wishes to do whatever is necessary to make the team successful. Parent and athletes will follow team rules set forth by the coach and this Athletic Code. Parents and students agree that they will read and abide by the guidelines presented in the “Communication Guidelines” brochure included in the athletic packet. The following are general responsibilities of the athlete.

Scholastic Eligibility and Grades: The student athlete must meet the Perris Union High School Board Policy and the

California Interscholastic Federation – Southern Section (C.I.F.–S.S.) academic standards. CIF-SS requires that a student be enrolled in and passing at least (4) four classes (if enrolled in P.E. class twice in one semester, only one counts towards the 20 credits). Additionally, Board Policy 6145 (a) requires that students pass a minimum of 20 credits, not including Pass/Fail classes (i.e. teacher’s aides positions). Lastly, students must be working towards minimum graduation requirements to be eligible. Eligibility is based upon the student’s last grading period. If a student does not meet these requirements, he/she becomes immediately ineligible and cannot participate in any games. He/she can regain their athletic eligibility at the end of the next grading period upon successful completion of the requirements mentioned above.

A period of eligibility will be equal to a period of ineligibility. Athletes become eligible and ineligible on the Monday after the grades are reported approximately every six-week period. Ineligible athletes may (at the coach’s discretion) practice with a team, but may not dress for a game, participate in any contest, or travel with a team when doing so would excuse them from class participation.

Conduct and Behavior: As athletes in High School, you are representing yourself, parents, school, and community

and are expected to conduct yourself properly at all times. Because of this, misconduct by an athlete will not be condoned. The Athlete Code is in effect from the first CIF sanctioned practice (August) through the last contest of the year. Athletes are responsible for compliance whether they play during one or all seasons of sport, fall, winter, and/or spring.

Game behavior: If an athlete is ejected from the game, the coach will discipline him/her according to

school, CIF, and team regulations. A written report will commence following the game with the school’s administration. CIF mandates that the athlete not be allowed to play or be present at the next scheduled contest. School administration reserves the right to discipline the athlete further.

Student Keeps

Language: Anyone associated with the High School will use language that is socially acceptable.

Profanity or vulgar talk will not be tolerated at any time on or off the playing field.

Respect: The athlete is to show respect for all coaches, teachers, officials, spectators, school

facilities and equipment. Training:

It is generally accepted that good training includes adequate rest, diet, health habits, and self-discipline.

Alcohol and drugs: Alcohol and/or drug abuse will be dealt with by the school site administration and will

include termination from athletic participation.

Tobacco including “chew”: Athletes who choose to use tobacco and “chew” will be dealt with by the school site

administration and will include termination from athletic participation.

Criminal Acts: Athletes who conspire to become involved in acts defined as criminal by statute are

subject to discipline under this code.

Violations of school discipline policy: Athletes are expected to display behavior in the classroom and on campus that is

exemplary for all students to follow. Therefore serious violations of school discipline – fighting for example –maybe considered a violation and put the student at risk of discipline that could include immediate termination of athletic participation.

Transportation: All athletes are expected to follow school and transportation rules set forth by the district

and the transportation company that is utilized. Perris Union High School District supplies the transportation to and from all athletic contests for all teams. If a student athlete wishes to make special arrangements, on an occasional basis, to receive a ride from a parent/guardian, arrangements must be made prior to the event and must include proper documentation.

Equipment: Athletes are financially responsible for any school owned equipment that is utilized or

rented out to the athlete. Athletes are expected to demonstrate reasonable care of such equipment, and any misuse or abuse of such, will be the financial responsibility of the athlete.

Appearance: As a member of our team, we want to be proud of your appearance. Athletes are expected

to dress neatly and keep well groomed. The coach may determine dress on the day of a contest.

Dedication: An athlete must be willing to dedicate himself/herself to the sport of choice. The athlete

should be aware that nothing worthwhile is accomplished without hard work and a sincere desire to succeed. The athlete must also realize that he or she must work out of season as well as in season. He or she must also be willing to sacrifice his or her own personal desires for the good of the team.

Quitting a sport: There is a distinct difference between “quitting” and being ‘dropped’ and being ‘cut’ from

a sport. If you as an athlete quit a sport, you forfeit your award and eligibility to continue that sport later. You will not be allowed to compete in any other sport in the same season. Dropping a sport is withdrawing from that sport voluntarily. Proper communication and returning of equipment to the coach is required. The coach’s approval is required to remain eligible for the remainder of the season.

Letters and Awards: Letters and awards are given according to team criteria. All coaches reserve the right to

award letters. However, all athletes must end the season in good standing, both academically and behaviorally, to earn a varsity letter. Again, the head coach of the team is the one who decides the awards process and who receives an award. All athletic participants who are recognized by the coach will receive a certificate of Athletic Recognition from the Athletic Department. Any other awards that are given through the school/team cannot be given unless the athlete/recipient has a valid ASB card. These awards are purchased by ASB and are not a requirement to be received through participation. Students with an ASB card are cleared through the Athletic Office to receive awards and/or letters.

Residence Eligibility: Any student, who is planning to move, has recently moved or whose parents or guardians

have moved, should notify the Athletic Director’s office for CIF information on his/her status of eligibility.

Seasonal Participation: An athlete may only participate in one sport per season unless otherwise granted

permission by the Athletic Director. Athletes cannot change from one sport to another during the season unless they have approval of both coaches and the Athletic Director. When an athlete quits or is dropped for disciplinary reasons, he/she may not go out for another sport until the end of that season (excluding playoffs). (This includes athletic PE.)

PUHSD Athletic/Activity Code: In order to emphasize academic achievement, the following constitute minimum

requirements for student participation in athletics and/or student activities: A grade point average of a “C” in all classes. Athletes must attend a minimum of 4 class periods of school on the day of a contest in

order to participate. Truancies from school for any portion of a school day is not acceptable and will result

in further discipline (i.e., game(s) suspension). He/she may not receive more than one “U” in citizenship in a grading period and must

pass 4 classes where only one can be PE and Teacher Assistant. PE can only beconsidered as one class for eligibility purposes. YOU MUST BE ENROLLED IN ANDPASS AT LEAST 4 CLASSES THAT YOU RECEIVE A “LETTER”GRADE.

Eligibility will be checked approximately every 6 weeks until the next grade checkperiod.

All transfer students outside the district must also meet eligibility requirements aswell as CIF requirements in order to participate.

Any student expelled will be ineligible for one semester upon return to the regularHigh School program.

Athletes MUST be on course to graduation by unit count.

This code takes effect in August and terminates with the last athletic/activity in June. This code is in effect 24 hours a day, 7 days a week, and including vacation days during the academic school year. It is also in effect during the summer period as long as the event is affiliated with the school. Ineligibility created by suspension from athletics/activities and not completed by the end of the spring semester will carryover for completion in the fall semester.

NCAA Clearinghouse: Any athlete desiring to attend college is well advised to become certified through the

NCAA Clearinghouse. You must start the certification process early – usually by the start of your junior year. It is your responsibility to contact your counselor and begin the process.

CIF- Eligibility: A student athlete:

1. Must be less than 19 years of age as of September 1 of the new academic year.2. Must have reached the ninth grade3. Must participate in no more than four seasons in the same sport after enrolling into the

ninth grade4. Must be scholastically eligible5. Must file an Application for Residential Eligibility if you transferred from another school

without a bona fide change of residence by your parents/guardians6. Since entering the ninth grade, must not be in your ninth semester of attendance.7. Must meet citizenship requirements8. Must maintain amateur standing9. Must not have participated in any tryout for a professional team10. Must maintain in your school files an annual physical examination card certifying that you

are physically fit to tryout and/or participate in athletics. Physical must be on approvedform by the PUHSD Board of Education

11. Cannot compete on an outside team during your High School season in the same sportseason.

12. May not participate on the Varsity Football team until he/she has reached his/her 15thbirthday unless certified by a doctor and granted written approval by the commissioner ofCIF.

13. May participate in all-star competition, with the exception of football, between conclusionof the Southern Section season of sport and September 1

14. Questions should be directed to your school coach and/or Athletic Director15. Must complete the Athlete’s Code of Ethics

CIF - Code of Ethics: As an athlete, I understand that it is my responsibility to:

1. Place academic achievement as the highest priority2. Show respect for teammates, opponents, officials and coaches3. Respect the integrity and judgment of game officials4. Exhibit fair play, sportsmanship and proper conduct on and off the playing field5. Maintain a high level of safety awareness6. Refrain from the use of profanity, vulgarity, and other offensive language and gestures7. Adhere to the established rules and standards of the game to be played8. Respect all the equipment and use it safely and appropriately9. 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 notapproved by the United States Food and Drug Administration or Surgeon General of theUnited States or the American Medical Association.

10. Know and follow all state, section and school athletic rules and regulations as they pertainto eligibility and sports participation.

11. WIN WITH CHARACTER, LOSE WITH DIGNITY.

Play it Safe Concussion CareSM ProgramIn cases of possible concussions, to help address the health and safety of youth athletes, your child’s athletic organization has implemented the Play It Safe Concussion CareSM program. This innovative program helps athletic organizations protect injured youth athletes by covering some of the examina-tion costs that may not have been otherwise covered. These procedures help the health care providers determine if it is safe for the athlete to return to the classroom and the playing field.

What is Play it Safe?The Play it Safe Concussion Care program is a secondary, excess insurance pol-icy for your athlete, that works together with your primary health insurance. Excess means this coverage will be effective only after any other insurance coverage you have has been fully applied. All active members of the team are covered while participating in a regularly scheduled athletic game or competi-tion, or a practice session for the team.

What the program coversThe excess policy covers your co-pays and deductibles for the athlete’s medi-cal care associated with a concussion. It also covers specific services that your primary insurance may not, such as:• Post Injury Neurocognitive testing• Health and behavior intervention• Office visits to medical providers specializing in concussion management• Magnetic Resonance Imaging (MRI) limited to spine and neck• Electroencephalogram (EEG) measures brain activityThe coverage period is within 52 weeks from date of injury. There are no de-ductibles to meet or co-pays owed for the covered services. Maximum benefit amount is $25,000 per injury.

Plan Brokered by:USI Insurance ServicesCA License No. 0D08408https://studentinsurance.usi.com

Underwritten by:National Union Fire Insurance Company of Pittsburgh, Pa.,

with its principal place of business in New York, NY

Services outside the programIt is also important to know that certain services are NOT covered under this excess policy. These include, but are not limited to:• Emergency services• Facility services (hospital, surgery centers)• Prescription drugs• Ambulance services• Surgical proceduresPlease note that this policy is limited to specific procedure codes, and each code has a maximum payable amount. There may be a balance due if the procedure code is not on the approved list, or if the procedure exceeds the maximum payable amount. For full policy details, please see the Master Policy available from your athletic organization.

Important noteThis is only a summary of the terms and conditions of the Play it Safe Concus-sion Care program. Payments, if any, depend on the terms and conditions contained in the master policy. If there are any differences between this sum-mary and the master policy, the terms and conditions of the policy will apply.

Questions?Contact the Claims Administrator:

AIG - A&H Claims DepartmentP O Box 25987

Shawnee Mission, KS 66225-5987Toll Free (800) 551-0824

Fax (866) 893-8574

What happens if my youth athlete sustains a concussion?When an athlete appears to have

sustained a concussion he or she is pulled from play and evaluated by

designated staff. As needed, the athlete is referred

for clinical assessment and specialty care.

Within 1 week, the parent should contact the athletic organization to complete an accident injury report.

Note: Both the parent and the athletic organizations have sections

to complete. Once complete, fax to AIG at (866) 893-8574 within 20

days of the incident.

The parent should obtain a referral form from the athletic organization that includes the name of the policy

holder (the school or league) and the policy number. This form must be provided to any and all medical providers treating the athlete for

concussion.

When a bill is received from a medical provider’s office, the

parent should call AIG at (800) 551-0824 to confirm that they have been billed by the doctor for

any remaining amounts due.*

AIG will send written notification showing what was covered by

the policy and whether there is a remaining balance due.

The athlete continues with follow-up care until cleared by a qualified

medical professional for safe return to play.

*Because of HIPAA regulations, your child’s athletic organization is limited in their ability to share information with medical providers regarding injuries.It is the parent’s responsibility to communicate with your insurance company, AIG, and the medical providers.

USI INSURANCE SERVICES PRIVACY INFORMATIONWe know that your privacy is important to you and we strive to protect the confidentiality of your personal information. We do not disclose any personal information about our plan participants, except as permitted or required by law (e.g., information you provide to us may be shared with your school to process your insurance transaction). To protect your personal information from unauthorized access and use, we use security measures that comply with federal law. These measures include computer safeguards and secured files and buildings. You may obtain a detailed copy of our privacy policy through your school or by calling us at (800) 853-5899 or by visiting us at http://www.usi.com/privacy.

Play It Safe Concussion Care℠

CONFIDENTIAL AND PROPRIETARY: The information, including but not limited to, text, graphics, images and other material contained in this document is for informational purposes only. The purpose of this document is to promote understanding and knowledge of the topics contained therein. It is not intended to be a substitute for professional risk management advice. USI does not accept any responsibility for the content of the information provided or for consequences of any actions taken on the basis of the information provided. © 2018 USI Insurance Services. All rights reserved.

*Please note that this is a brief summary of guidelines. The full policy can be obtained through your organization.

CONTACTS AIG Insurance: Phone 800-551-0824 ● Fax 866-893-8577 ● Email: ahclaimssubmissions@AIG.com

USI Play It Safe: 888-857-9504

Our Organization’s Preferred Provider: ______________________________________

When an athlete is evaluated and appears to have sustained a concussion

ATC/Staff refers athlete to a medical provider who is trainedin the management of concussion.

Athlete then undergoes an evaluation which includes a post-injury test.*

*Post-injury test must be performed by medical provider, not team staff

The medical provider provides the athlete with an individual follow-up plan that may include rest, gradual re-exertion, and re-evaluation.

ATC/Staff faxes completed claim form with parent signature to AIG within 20 calendar days of the date of injury.

Medical expenses incurred by the athlete while under care of the medical professional are submitted to the athlete's primary health insurance.

Itemized bills and primary insurance explanation of benefits are submitted to AIG for consideration of payment.

In the absence of other coverage, this coverage will provide benefits subject to the coverage limits and exclusions.

PLAY IT SAFE GUIDELINES* FOR COVERED ATHLETES

Injury occurs

Athlete referred to providertrained in the evaluation

and managementof concussion

Comparison of post-concussiveperformance and symptoms

to baseline test levels

Re-evaluation, rest,gradual exertion

Safe return to play

Claim form completed by school and parentand taken to a provider trained in the evaluation

and management of concussion

Follow-upsas needed

Pre-season ImPACTbaseline test

Post-injury ImPACT testperformed in

provider’s office

Athlete evaluatedand removed

from play

PUHSD Concussion Management Program

BEAT THE HEATSummer's high temperatures put student athletes at increased risk of heat illness. There are several types of heat illness. They range in severity, from heat cramps and heat exhaustion, which are common but not severe, to heat stroke, which can be deadly. Although heat illnesses can be fatal, death is preventable if they’re quickly recognized and properly treated.

Sources: Korey Stringer Institute, American Medical Society for Sports Medicine, NATA

• From 2010-15, 20 athletic heat stroke fatalities were reported.

• It takes seven to 14 days for a body to adapt to exercising in the heat.

• Dehydration at levels of 3 to 4 percent body mass loss can reduce muscle strength by anestimated 2 percent.

DEHYDRATION AND HEAT ILLNESSES

EARLY WARNING SIGNS OF EXERTIONAL HEAT STROKE

Chills and/or goose bumps

Headache, dizziness, confusion and disorientation

Nausea and/or vomiting

Excessive sweating and/or flushing

Fatigue

Lightheadedness, when not associated with other symptoms

Dizziness

Cramps, muscular tightening and spasms

Currently, 13 states have heat-acclimatization policies, for secondary school athletics with New Jersey being the first.

Exertional heat stroke is one of the top three killers of athletes and soldiers in training.

As a rule-of-thumb, most athletes should consume 200 to 300 milliliters of fluid every

MINUTES

of exercise.15It takes only 30 minutes for cell damage to occur with a core body temperature of 105 degrees.

Signs of nervous system dysfunction, such as confusion, aggression and loss of consciousness

Core body temperature of more than 105 degrees

Low blood pressure

Rapid breathing

Seizures

Increased heart rate

Remove unnecessary equipment, such as helmets and padding, when environmental conditions become extreme.

Clothing worn by athletes should be light colored, lightweight and protect against the sun.

Infographic courtesy of the National Athletic Trainers' Association, www.nata.org

• For the first week or so, hold shorter practices with lighter equipment so players canacclimate to the heat.

• Follow a work-to-rest ratio, such as 10-minute breaks after 40 minutes of exercise.

• Get an accurate measurement of heat stress using a wet-bulb globe temperature, whichaccounts for ambient temperature, relative humidity and radiation from the sun.

• If someone is suffering from exertional heat stroke, remember to cool first and transport second.

• Have large cold tubs ready before all practices and games in case cold water immersion isneeded to treat exertional heat stroke.

SAFETY TIPS

Have sports drinks on hand for workout sessions lasting longer than an hour.

Keep beverages cold – cold beverages are consumed 50 percent more than warm beverages.

Hydrate before, during and after activity.

�TTENTION:

ALL FORMS AFTER THIS PAGE ARE

PART OF THE THE SIGNATURE

CONSOLIDATION PAGE.

THE ITEMS YOU ARE SIGNING FOR ON

THE SIGNATURE CONSOLIDATION

PAGE REFER TO THE FOLLOWING

PAGES. THERE IS NO NEED FOR YOU

TO SIGN THESE PAGES.

PLEASE KEEP A COPY OF THESE PAGES

FOR YOUR REFERENCE.

Student Record and Media Release Authorization

Athletic Department

Signature by the parent/legal guardian indicates full consent and authorization to release any information in regard to the aforementioned student. This information will be released to university and/or college coaches that show interest in the student named below. As well as school Booster Club publications, school Web sites and team rosters.

Please complete this form and return to the school where it will be kept on file for future reference.

Information may include but is not limited to:

• Athletic statistics (Sport specific, weightlifting)

• Grades, transcripts

• Height, weight and grade classification

• Name and/or picture(s) in the school newspaper(s)

• Name and/or picture(s) in the school web page(s)

• Pictures for rosters and publications

• Phone and address list to be used for Booster Club help

• Scores on standardized intelligence tests

• Standardized Achievement Scores (ACT, SAT)

This release is in accordance with the provisions of the Family Educational Rights and Privacy Act of 1974. See reverse for more information regarding FERPA.

_____________________________________________ _________________________________________ ________________ (please print) Parent/Legal Guardian Signature Date

School Name: Athletic Direct/Dean:

Student Information First Name: Last Name: Date of Birth: Grade:

The Family Educational Rights and Privacy Act (FERPA) (20 U.S.C. § 1232g; 34 CFR Part 99) is a Federal law that protects the privacy of student education records. The law applies to all schools that receive funds under an applicable program of the U.S. Department of Education.

FERPA gives parents certain rights with respect to their children's education records. These rights transfer to the student when he or she reaches the age of 18 or attends a school beyond the high school level. Students to whom the rights have transferred are "eligible students."

• Parents or eligible students have the right to inspect and review the student's education recordsmaintained by the school. Schools are not required to provide copies of records unless, forreasons such as great distance, it is impossible for parents or eligible students to review therecords. Schools may charge a fee for copies.

• Parents or eligible students have the right to request that a school correct records which theybelieve to be inaccurate or misleading. If the school decides not to amend the record, the parentor eligible student then has the right to a formal hearing. After the hearing, if the school stilldecides not to amend the record, the parent or eligible student has the right to place a statementwith the record setting forth his or her view about the contested information.

• Generally, schools must have written permission from the parent or eligible student in order torelease any information from a student's education record. However, FERPA allows schools todisclose those records, without consent, to the following parties or under the followingconditions (34 CFR § 99.31):

School officials with legitimate educational interest; Other schools to which a student is transferring; Specified officials for audit or evaluation purposes; Appropriate parties in connection with financial aid to a student; Organizations conducting certain studies for or on behalf of the school; Accrediting organizations; To comply with a judicial order or lawfully issued subpoena; Appropriate officials in cases of health and safety emergencies; and State and local authorities, within a juvenile justice system, pursuant to specific State law.

Schools may disclose, without consent, "directory" information such as a student's name, address, telephone number, date and place of birth, honors and awards, and dates of attendance. However, schools must tell parents and eligible students about directory information and allow parents and eligible students a reasonable amount of time to request that the school not disclose directory information about them. Schools must notify parents and eligible students annually of their rights under FERPA. The actual means of notification (special letter, inclusion in a PTA bulletin, student handbook, or newspaper article) is left to the discretion of each school.

For additional information, you may call 1-800-USA-LEARN (1-800-872-5327) (voice). Individuals who use TDD may call 1-800-437-0833.

Or you may contact us at the following address:

Family Policy Compliance Office U.S. Department of Education 400 Maryland Avenue, SW Washington, D.C. 20202-852

Perris Union High School District 155 E. 4th Street Perris, CA 92570

Athletic Release of Liability

School Site: __________________________________ School Year 20____ to 20 _____

Please complete and return to the Athletic Office at your school site.

Part 1.

I have read and agree with the information contained in the Athletic Participation Expectations document.

____________________________________________ ________________________________________ ________________ Name of Student (Print) Signature of Student Date

Part 2. Summer Program Liability Release

Traditionally, voluntary summer athletic programs are held throughout the school district. Be aware that these programs are strictly voluntary on the part of the coaches and the students who participate. Perris Union High School District does not assume any liability for your child’s participation in these programs for either practice or competition. This includes transportation to and from any related even and/or any fees incurred. Days beyond the regular school year session determine the time frame of a summer program. Any athletic activity outside of the regular school year session is considered voluntary and Perris Union High School District is not held liable for activity during this period.

Part 3.

I/we have been made aware of and understand the risk and liability of high school sports and the threat of possible injury and/or even death in the event of a high school athletic event. Included in this release are the additional possible threat and/or injury for the exclusive sport of football. By signing this form, you acknowledge that fact that you (the parent/legal guardian of the athlete) are aware of all possible injuries in playing high school football and/or any other high school sport. Further that the athlete must be medically insured (including football coverage), at the expense of the family, in order to be cleared to participate in any athletic program.

This form must be completed and signed by the student and parent/guardian prior to any involvement in the Perris Union High School District Athletic programs, either voluntary in the summer or during the regular school year. Further, for your own protection and safety, each student must have a current physical clearance on file which includes a fully completed physical examination/emergency form.

As stated in the California Education Code, Section 35330, I understand that I hold the Perris Union High School District, its officers, agents, and employees harmless from any and all liabilities or claims which may arise out of or in connection with my child’s participation in the voluntary summer athletic program.

_________________________________________________ ________________________________________ ________________ Name of Student (Print) Student Signature Date

_________________________________________________ ________________________________________ ________________ Parent/Guardian (Print) Parent Signature Date

Insurance: It is mandatory that every athlete be covered by medical insurance. Neither the District nor the High School pay for

any medical care of injured athletes, nor do they provide insurance coverage. If you do have insurance, please check with your provider and make certain that they cover football related injuries. In the event you do not have football coverage through your company or do not have medical insurances at all, you may enlist in an insurance program provided to the school by Myers-Stevens & Toohey & Co. You may obtain this information in the form of a brochure from the athletic office.

Transportation: All athletes are expected to follow school and transportation rules set forth by the district and the transportation

company that is utilized. Perris Union High School District supplies the transportation to and from all athletic contests for all teams. If a student athlete wishes to make special arrangements, on an occasional basis, to receive a ride from a parent/guardian, arrangements must be made prior to the event and must include proper documentation.

PERRIS UNION HIGH SCHOOL DISTRICT  SYNTHETIC TURF FIELD RULES ­ PUHSD STUDENTS

• Molded Cleats or other Athletic shoes only: Not to exceed 1/2” molded orscrew cleats as anything higher can result in increased risk for injury and/ordamage to the field.

• No sharp objects including tent stakes, corner flags or other objects that canpenetrate the surface of the field.

• No food items including gum and sunflower seeds.

• No tobacco products of any kind.

• No smoking on or around the field.

• No sports drinks or liquids, other than water.

• No pets.

• No bicycles or other unapproved vehicles.

School: _______________________________________________ 

Parent/Guardian Signature: _________________________    Date: __________

Student Signature: _________________________________  Date: __________ 

A Sudden Cardiac Arrest Information Sheet for Athletes and Parents/Guardians

What is sudden cardiac arrest? Sudden cardiac arrest (SCA) is when the heart stops beating, suddenly and unexpectedly.When this happens blood stops flowing to the brain and other vital organs. SCA is NOT aheart attack. A heart attack is caused by a blockage that stops the flow of blood to theheart. SCA is a malfunction in the heart’s electrical system, causing the victim to collapse.The malfunction is caused by a congenital or genetic defect in the heart’s structure.How common is sudden cardiac arrest in the United States? As the leading cause of death in the U.S., there are more than 300,000 cardiac arrestsoutside hospitals each year, with nine out of 10 resulting in death. Thousands ofsudden cardiac arrests occur among youth, as it is the #2 cause of death under 25and the #1 killer of student athletes during exercise.

Who is at risk for sudden cardiac arrest?SCA is more likely to occur during exercise or physicalactivity, so student-athletes are at greater risk. Whilea heart condition may have no warning signs, studiesshow that many young people do have symptoms butneglect to tell an adult. This may be because they areembarrassed, they do not want to jeopardize their play-ing time, they mistakenly think they’re out of shape and need to train harder, orthey simply ignore the symptoms, assuming they will “just go away.” Additionally,some health history factors increase the risk of SCA.

What should you do if your student-athlete is experiencing any of thesesymptoms? We need to let student-athletes know that if they experience any SCA-relatedsymptoms it is crucial to alert an adult and get follow-up care as soon as possiblewith a primary care physician. If the athlete has any of the SCA risk factors, theseshould also be discussed with a doctor to determine if further testing is needed.Wait for your doctor’s feedback before returning to play, and alert your coach,trainer and school nurse about any diagnosed conditions.

The Cardiac Chain of SurvivalOn average it takes EMS teams up to 12 minutes to arrive

to a cardiac emergency. Every minute delay in attending

to a sudden cardiac arrest victim decreases the chance

of survival by 10%. Everyone should be prepared to take

action in the first minutes of collapse.

Early Recognition of Sudden Cardiac ArrestCollapsed and unresponsive.Gasping, gurgling, snorting, moaning or labored breathing noises.Seizure-like activity.

Early Access to 9-1-1Confirm unresponsiveness.Call 9-1-1 and follow emergency dispatcher's instructions.Call any on-site Emergency Responders.

Early CPRBegin cardiopulmonary resuscitation(CPR) immediately. Hands-only CPR involves fastand continual two-inch chest compressions—about 100 per minute.

Early DefibrillationImmediately retrieve and use an automated external defibrillator (AED) as soon as possible to restore the heart to its normal rhythm. MobileAED units have step-by-step instructions for a by-stander to use in an emergency situation.

Early Advanced CareEmergency Medical Services (EMS) Responders begin advanced life support including additional resuscitative measures andtransfer to a hospital.

Cardiac Chain of Survival Courtesy of Parent Heart Watch

What is an AED? An automated external defibrillator (AED) is the only way to save a suddencardiac arrest victim. An AED is a portable, user-friendly device that automat-

ically diagnoses potentially life-threatening heartrhythms and delivers an electric shock to restore nor-mal rhythm. Anyone can operate an AED, regardless oftraining. Simple audio direction instructs the rescuerwhen to press a button to deliver the shock, whileother AEDs provide an automatic shock if a fatal heartrhythm is detected. A rescuer cannot accidently hurt a

victim with an AED—quick action can only help. AEDs are designed to onlyshock victims whose hearts need to be restored to a healthy rhythm. Checkwith your school for locations of on-campus AEDs.

A E D

FAINTINGis the

#1SYMPTOMOF A HEART CONDITION

Keep Their Heart in the Game

Recognize the Warning Signs & Risk Factorsof Sudden Cardiac Arrest (SCA)

Tell Your Coach and Consult Your Doctor if These Conditions are Present in Your Student-Athlete

What is CIF doing to help protect student-athletes?CIF amended its bylaws to include language that adds SCA training to coach certification and practice and game protocol that empowers coaches toremove from play a student-athlete who exhibits fainting—the number one warning sign of a potential heart condition. A student-athlete who has beenremoved from play after displaying signs or symptoms associated with SCA may not return to play until he or she is evaluated and cleared by a licensedhealth care provider. Parents, guardians and caregivers are urged to dialogue with student-athletes about their heart health and everyone associatedwith high school sports should be familiar with the cardiac chain of survival so they are prepared in the event of a cardiac emergency.

I have reviewed and understand the symptoms and warning signs of SCA and the new CIF protocol to incorporate SCA prevention strategies into my stu-dent’s sports program.

STUDENT-ATHLETE SIGNATURE PRINT STUDENT-ATHLETE’S NAME DATE

PARENT/GUARDIAN SIGNATURE PRINT PARENT/GUARDIAN’S NAME DATE

For more information about Sudden Cardiac Arrest visit

California Interscholastic Federation Eric Paredes Save A Life Foundation CardiacWise (20-minute training video)http.www.cifstate.org http:www.epsavealife.org http.www.sportsafetyinternational.org

Potential Indicators That SCA May Occur� Fainting or seizure, especially during or

right after exercise

� Fainting repeatedly or with excitement orstartle

� Excessive shortness of breath during exercise

� Racing or fluttering heart palpitations or irregular heartbeat

� Repeated dizziness or lightheadedness

� Chest pain or discomfort with exercise

� Excessive, unexpected fatigue during orafter exercise

Factors That Increase the Risk of SCA� Family history of known heart abnormalities or

sudden death before age 50

� Specific family history of Long QT Syndrome, Brugada Syndrome, Hypertrophic Cardiomyopathy, orArrhythmogenic Right Ventricular Dysplasia (ARVD)

� Family members with unexplained fainting, seizures,drowning or near drowning or car accidents

� Known structural heart abnormality, repaired or unrepaired

� Use of drugs, such as cocaine, inhalants, “recreational” drugs, excessive energy drinks or performance-enhancing supplements

Keep Their Heart in the Game

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ImPACT CONCUSSION MANAGEMENT PROGRAM CONSENT FORM and RELEASE OF INFORMATION

For Use of Baseline Cognitive AND Post-Concussion Cognitive Testing

Perris Union High School District is utilizing an innovative program for our student-athletes that will assist our team

physicians/athletic trainers in evaluating and treating traumatic brain injuries (e.g., concussion). To help these trained

healthcare professionals to better manage concussions sustained by our athletes, we have acquired a software tool called

ImPACT (Immediate post Concussion Assessment and Cognitive Testing). ImPACT is a computerized exam used in

many professional, collegiate, and high school sports programs across the country. If an athlete is believed to have

suffered a head injury during practice or competition, ImPACT is a tool that can be used by a trained healthcare

professional to evaluate the severity of the head injury and the athlete’s recovery from that injury.

Ideally, the computerized exam is given to athletes before beginning contact sport practice or competition. This simple,

non-invasive test is set up in a video-game type format and takes about 20 minutes to complete. It tracks information such

as memory, reaction time, speed, and concentration. In addition, to help healthcare providers better understand the

athlete’s particular healthcare situation, there also are questions about the athlete’s health history as well as current

symptoms that he or she may be experiencing. ImPACT is not an IQ test.

If a concussion is suspected, the athlete will be required to re-take the test. The athlete’s performance on the post-injury

test will be compared to his or her performance on the baseline and any differences in performance will be evaluated by a

trained healthcare provider. The test data will enable trained healthcare professionals to determine when return-to-activity

is appropriate and safe for the injured child.

The ImPACT testing procedures are non-invasive and pose no known risks to your student-athlete. We are excited to

implement this program because it provides us the best available information for managing concussions.

I give my permission for my child to participate in the ImPACT Concussion Management Program, which may

include Baseline Cognitive testing, and Immediate Post-Concussion Cognitive Testing, administered by Perris

Union High School District staff, athletic trainers or an ImPACT Certified Physician. I understand that my child

may need to be tested more than once, depending upon the results of the test, and that the ImPACT testing

procedures are non-invasive and pose no known risks to my child. I understand that there is no charge for the

testing.

I understand that Perris Union High School District may release the ImPACT test results to my child’s primary

care physician, neurologist, other treating physician, or any licensed healthcare professional.

I understand that general information about the test data may be provided to my child’s guidance counselor and

teachers, for the purposes of providing temporary academic modifications, if necessary.