Safety Guidelines for Secondary Interschool Athletics in Alberta

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APPENDIX B - Sample Secondary Interschool Athletic Activity Student Athlete Information and Consent Form This form should be completed on behalf of each team member participating in secondary interschool athletic activities and returned to the teacher/coach prior to the first competition. 70 Student Athlete Name:_______________________________________________________________ Home Phone: ______________________________________________________________________ Home address: _____________________________________________________________________ City:_________________________________________ Postal Code:__________________________ Alberta Health Care #: _______________________________________________________________ Parent/Guardian:____________________________________________________________________ Work Phone #: ____________________________ Cell Phone #: _____________________________ Student Athlete’s Physician: _____________________________________ Phone #: ____________ Emergency Contact Person: ______________________________________ Phone #: ____________ MEDICAL INFORMATION Date of last complete medical examination: _______________________________________________ NOTE: An annual medical examination is recommended. Date of last tetanus immunization: ______________________________________________________ Is your son/daughter/ward allergic to any drugs, foods or medication/other? Yes No If yes, provide details:________________________________________________________________ Does your son/daughter/ward take any prescription drugs? Yes No If yes, provide details:________________________________________________________________ What medication(s) should the student athlete have on hand during the interschool athletic activity? ___________________________________________________________________________________ Who should administer the medication?___________________________________________________ I, the parent/guardian of (student athlete name), give permission for the teacher/coach to administer this medication(s) to the student athlete as directed or needed. Signature: _________________________________________________________________________ Date: _____________________________________________________________________________ Or Although the student athlete can under normal circumstances administer his/her own medication, I, the parent/guardian of (student athlete name), give permission for the teacher/coach/teacher to administer the medication if an injury/illness prevents the student athlete from doing so themselves. Signature: _________________________________________________________________________ Date: _____________________________________________________________________________ Continuned on next page Safety Guidelines for Secondary Interschool Athletics in Alberta - February 2012
Continued from previous page Does your son/daughter/ward wear a medical alert bracelet, neck chain or carry a medical alert card? Yes No If yes, please specify what is written on it: ________________________________________________ Does your son/daughter/ward wear eyeglasses? Yes No Contact lenses? Yes No Please indicate (check the box) if your son/daughter/ward has been subject to any of the following and provide pertinent details: epilepsy diabetes orthopedic problems (e.g., knee) cardiovascular conditions (heart / blood pressure) asthma, allergies head or back conditions or injuries (in the past two years) arthritis or rheumatism chronic nosebleeds dizziness fainting headaches, concussions dislocated shoulder hernia swollen, hyper-mobile or painful joints Please explain any other medical conditions that will limit participation._________________________ ___________________________________________________________________________________ ___________________________________________________________________________________ MEDICAL SERVICES AUTHORIZATION In case of emergency medical or hospital services being required by the above listed student athlete, and with the understanding that every reasonable effort will be made by the school/hospital to contact me, my signature on this form authorizes medical personnel and/or hospital to administer medical and/or surgical services including anesthesia and drugs. I understand that any cost will be my responsibility. Signature parent/guardian: ____________________________________________________________ Date: _____________________________________________________________________________ Continued on next page Safety Guidelines for Secondary Interschool Athletics in Alberta - February 2012 71
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Safety Guidelines for Secondary Int
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ii Safety Guidelines for Secondary
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TABLE OF CONTENTS Curling .........
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Types of Policies Recommended for S
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Continued from previous page Avoidi
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HOW TO USE THIS DOCUMENT How to Use
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Continued from previous page • In
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Continued from previous page Offici
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Continued from previous page 2. On-
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Continued from previous page Partic
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Continued from previous page • Ap
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Continued from previous page Cultur
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LOWER MAGNITUDE OF RISK SPORTS Lowe
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Continued from previous page Specia
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Continued from previous page Playin
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26 Safety Guidelines for Secondary
Page 40 and 41: Safety Guidelines for Secondary Int
Page 42 and 43: Continued from previous page o No d
Page 46 and 47: Continued from previous page Commun
Page 48 and 49: 32 Safety Guidelines for Secondary
Page 52 and 53: 34 Safety Guidelines for Secondary
Page 54 and 55: BASEBALL - FASTBALL All Interschool
Page 56 and 57: CHEER (ACROBATIC) Cheer (Acrobatic)
Page 58 and 59: CHEER (Pom) All Physical Activities
Page 60 and 61: CROSS COUNTRY RUNNING All Physical
Page 62 and 63: DIVING All Physical Activities pg.
Page 64 and 65: FOOTBALL (FLAG, TOUCH) All Physical
Page 66 and 67: GOLF All Physical Activities pg. 1l
Page 68 and 69: RUGBY (FLAG) All Physical Activitie
Page 70 and 71: SOFTBALL (SLOW-PITCH) All Physical
Page 72 and 73: TEAM HANDBALL All Physical Activiti
Page 74 and 75: TRACK AND FIELD - HIGH JUMP All Phy
Page 76 and 77: TRACK AND FIELD - POLE VAULT Track
Page 78 and 79: TRACK AND FIELD • TRIPLE JUMP •
Page 80 and 81: TRIATHLON • SWIM • BIKE • RUN
Page 82 and 83: VOLLEYBALL (INDOOR AND OUTDOOR) All
Page 84 and 85: WRESTLING All Physical Activities p
Page 88 and 89: APPENDIX A - Sample Secondary Inter
Page 92 and 93: Continued from previous page ACKNOW
Page 94 and 95: 3. Facility Area: Gymnasium Hallway
Page 96 and 97: APPENDIX E - SAMPLE Form for Off-si
Page 98 and 99: Continued from previous page Have y
Page 100 and 101: Continued from previous page 5. Wha
Page 102 and 103: 82 APPENDIX I - Sample Safety Check
Page 104 and 105: APPENDIX J SAMPLE SAFETY CHECKLIST
Page 106 and 107: APPENDIX K - SAMPLE SAFETY CHECKLIS
Page 108 and 109: APPENDIX L - Sample Emergency Actio
Page 110 and 111: Appendix M - Sample Medical History
Page 112 and 113: APPENDIX O - ATHLETIC FIRST AID KIT
Page 114 and 115: APPENDIX Q - Policy for the Alberta
Page 116 and 117: Continued from previous page 5. Any
Page 118 and 119: 98 Continued from previous page 2.
Page 120 and 121: Continued from previous page implem
Page 122 and 123: APPENDIX S - Suggested Criteria For
Page 124 and 125: Continued from previous page 4. A t
Page 126 and 127: Association Web Link Phone Squash A
Page 128 and 129: APPENDIX W - WATER SAFETY The follo
Page 130 and 131: isk level school authority supervis
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