Brookings School District Activity Participant Packet
In order to complete the 2018-2019 Activity Participant Packet, please read all of the information below and then complete the Activity Participant Packet Form online at the link at the bottom of this page.
ATTENTION: PARENTS/LEGAL GUARDIANS AND ACTIVITY PARTICIPANTS
WARNING AND SAFETY STATEMENT
Although participation in supervised interscholastic athletics and activities may be one of the least hazardous any student will engage in; by its nature, participation in interscholastic activities includes a risk of injury which may range in severity from minor to catastrophic injuries, including permanent paralysis or death. Serious injuries are not common in supervised school activity programs; however, it is possible only to minimize not to eliminate this risk.
All students participating in interscholastic activities are required to have medical insurance. Please check the appropriate line below.
BHS has insurance applications for school-time and full-time insurance coverages, if you do not have family medical insurance.
YEAR ROUND ACTIVITY RULES
We have read the Brookings School District year round Activity Rules (Board Policy JJC) and agrees to abide by its rules and regulations.
SDHSAA IN-SEASON RULE
A student who is a member of a high school team may not participate in games, practice, tryouts in that particular sport during the same season on an independent or non-high school team or as a member of an “All Star” team. Violation of this rule causes the student to become ineligible for the high school team for the remainder of that sport season.
ANNUAL PARENT & STUDENT CONSENT
The Parent and Student hereby:
1. Understand and agree that participation in SDHSAA sponsored activities is voluntary on the part of the student and is considered a privilege.
2. Understand and agree that (a) by this Consent Form the SDHSAA has provided notification to the parent and student of the existence of potential dangers associated with athletic participation; (b) participation in any athletic activity may involve injury or some type; (c) the severity of such injuries can range from minor cuts, bruises, sprains, and muscle strains to more serious injuries such as injuries to the body’s bones, joints, ligaments, tendons, or muscles. Catastrophic injuries to the head, neck and spinal cord and concussions may also occur. On rare occasions, injuries so severe as to result in total disability, paralysis and death; and (d) even with the best coaching, use of the best protetive equipment, and strict observance of rules, injuries are still a possibility.
3. Consent and agree to participation of the student in SDHSAA activities subject to all SDHSAA bylaws and rules interpretations for participation in SDHSAA sponsored activities, and the activities rules of the SDHSAA member school for which the student is participating; and
4. Consent and agree that personally identifiable directory information may be disclosed about the student as a result of his/her participation in SDHSAA sponsored activities. Such directory information may include, but is not limited to, the student’s photograph, name, grade level, height, weight, and participation in officially recognized activities and sports. If I do not wish to have any or all such information disclosed, I must notify the above mentioned high school, in writing, of our refusal to allow disclosure of any or all such information prior to the student’s participation in sponsored activities.
CONSENT FOR RELEASE OF MEDICAL INFORMATION (HIPPA)
1. I authorize the use of disclosure of the below named individual’s health information including the Initial Pre-Participation History and Physical Exam information pertaining to a student’s ability to participate in SDHSAA sponsored activities. Such disclosure may be made by any Health Care Provider generating or maintaining such information.
2. The information identified above may be used by or disclosed to the school nurse, athletic trainer, coaches, medical providers and other school personnel involved in the care of this student.
3. This information for which I am authorizing disclosure will be used for the purpose of determining the student’s eligibility to participate in extracurricular activities, any limitations on such participation and any treatment needs of the student.
4. I understand that I have a right to revoke this authorization at any time. I understand that if I revoke this authorization, I must do so in writing and present my written revocation to the school administration. I understand that the revocation will not apply to information that has already been released in response to this authorization. I understand that the revocation will not apply to my insurance company when the law provides my insurer with the right to contest a claim under my policy.
5. This authorization will expire on July 1, 2019.
6. I understand that once the above information is disclosed, it may be re-disclosed by the recipient and the information may not be protected by federal privacy laws or regulations.
7. I understand authorizing the use or disclosure of the information identified above is voluntary. However, a student’s eligibility to participate in extracurricular activities depends on such authorization. I need not sign this form to ensure healthcare treatment.
ACKNOWLEDGEMENT OF RISK
Activity participation assumes the risk of personal injury. Such injuries are not limited to, but may range in severity from temporary injuries (sprains, dislocations, fractures, etc.) to major, catastrophic injuries (brain damage, paralysis, etc.) that can result in permanent disability or death. While certain activities (i.e. contact sports, gymnastics, pole vault, cheerleading, etc.) involve greater risk; protective equipment, rule changes, advances in sports medicine, and improved coaching techniques cannot eliminate the possibility of injury in any activity.
CONSENT FOR MEDICAL TREATMENT
In the event of an injury, accident, or general medical condition which requires first aid/medical attention while my son/daughter is under the supervision of the Brookings School District, I hereby grant permission to the school employee, physician, or other medical personnel to perform any necessary medical treatment (including but not limited to x-ray, anesthetic, surgery, dental, hospitalization).
Furthermore, I understand that I will be responsible for all medical expenses.Participation in student activities involves a commitment to the group and school to perform to my capabilities. As a voluntary participant in an activity at Brookings High School, I agree to:1. Comply with SDHSAA eligibility requirements.2. Comply with the Student Conduct – Student Activities Policy.3. Submit all activity department forms as required4. Care for activity department equipment and uniforms during the participation period, and either return them at the conclusion of my participation or reimburse the Brookings School District at current, replacement costs.5. Conduct myself as a role model in school activities and in public so I will bring credit to Brookings High School and my activity group.6. Abide by Brookings High School attendance requirements.7. Be present at all meetings, practices and events unless excused prior to the absence. I understand that family and religious obligations, activity conflicts and academic responsibilities are valid excuses, but that I may not be excused for social and work reasons.8. Participate with motivation, dedication, sportsmanship, and self-discipline.9. Comply with all Brookings High School, activity department, Board of Education, ESD Athletic Conference and SDHSAA rules and policies as applicable.10. Abide by all rules as established by my advisor, coach, or director.