Redlands Unified Athletics Building Character, Class and Confidence

Redlands Unified School District Educational Services Division

Student Services Department P.O. Box 3008 Redlands, California 92373-1508 (909) 307-5300 FAX (909) 792-3847

Dear Student-Athlete and Parent: Welcome to Redlands Unified School District Athletics! The Redlands Unified Athletic Program will strive to provide as many positive competitive experiences for as many students as possible. Our program will search for excellence by giving one’s best effort. The Redlands Unified Athletic Program is dedicated to help student-athletes enhance their academic performance level, improve positive character traits, strive for excellence and increase their overall level of confidence through athletic competition. We are dedicated to “Pursuing Victory with Honor”, to adhering to the rules of competition and sportsmanship, and to displaying the Six Pillars of Character (trustworthiness, respect, responsibility, fairness, caring, and citizenship) on and off the playing field. Redlands Unified Athletics has much to offer! Our incredible coaches, supportive administrators, outgoing student bodies and parents, as well as the entire “Redlands Community”, are unified in making this a memorable experience for everyone involved. I hope that you enjoy your time at Citrus Valley High School, Redlands East Valley High School or Redlands High School. Best of luck, Pat Hafley Coordinator of Athletics

4/18/14 ph

REDLANDS UNIFIED SCHOOL DISTRICT ATHLETIC CLEARANCE/PARTICIPATION PACKET

Attention Parents: Students trying out for any athletic team within the Redlands Unified School District must have the following forms completed and returned to their school’s Athletic Office (Citrus Valley High School, Redlands East Valley High School or Redlands High School) before the first day of tryouts/workouts. DO NOT OMIT ANY SIGNATURE OR FORM FROM THE PACKET. Please note the parent and/or guardian must sign EVERY form IMPORTANT: YOUR STUDENT’S ACADEMIC ELIGIBILITY WILL BE DETERMINED FROM THE MOST RECENT GRADING PERIOD AND WILL BE VERIFIED AT THE TIME THESE FORMS ARE RETURNED TO THE ATHLETIC OFFICE. STUDENT-ATHLETES MUST PASS A MINIMUM OF 20 CREDITS EACH GRADING PERIOD WITH A MINIMUMOF A 2.0 GRADE POINT AVERAGE (GPA). CONSENT TO TREATMENT (Page #1): Form must be completed and signed by a Parent/Guardian. A copy of this page will be returned to the student-athlete to give to his/her coach along with a clearance card. PHYSICAL EXAMINATION FORM (Pages #2 & #3): Must be COMPLETED, signed, and STAMPED by a PHYSICIAN (MD or DO), PARENT/GUARDIAN and the STUDENT-ATHLETE. (First page filled out by parent/guardian and student-athlete; second page by the physician.) Physical exams completed by chiropractors will not be accepted. CONCUSSION INFORMATION (pages #4 & #5): CIF/Education Code requirement must be signed by student-athlete & parent. INSURANCE COVERAGE FORM (Page #6): Must be completed and signed by a Parent/Guardian. EVERY STUDENT MUST BE COVERED BY MEDICAL INSURANCE. We need to know the name of the insurance company and policy number. If you do not have medical coverage, forms are available from your school’s Athletic Office (CVHS, REV or RHS) to purchase Myers-Stevens Insurance. We strongly recommend the high option plans for students participating in interscholastic sports. CONSENT TO PARTICIPATE (Page #7): Form must be signed by both parents/guardian and student-athlete. Please read carefully and note areas where parent/guardian must initial. This form covers release and discharge of RUSD from all medical liability; medical release clearances; attendance/academic expectations, and transportation to-and-from game policy. ATHLETIC RESIDENTIAL VERIFICATION: IT IS IMPORTANT TO READ THE ENTIRE FORM AS YOUR CHILD’S ELIGIBILITY COULD BE AFFECTED (Page #8). CIF eligibility requirement must be signed by both parents/guardian. BOARD POLICY (Pages #9 & #10): This form contains information on the RUSD Board Policy regarding participation in co-curricular activities. It must be signed by both parents/guardian. ATHLETE CIF/REDLANDS UNIFIED SCHOOL DISTRICT CODE OF ETHICS (Pages #11 & #12): Student-athlete, parent/guardian must sign. PARENT CODE OF CONDUCT (Page #13): Parent/guardian must sign. NCAA DIVISION I AND DIVISION II INITIAL ELIGIBILITY REQUIREMENTS (Page #14 & #15): NCAA Initial Eligibility Requirements quick reference page must be signed by the student-athlete and parent. ASB STICKER: All students must purchase an ASB sticker in order to receive an athletic cloth letter and insert. PARENTS/GUARDIANS ARE ENCOURAGED TO MAKE COPIES OF ALL DOCUMENTS PRIOR TO RETURNING ALL SIGNED FORMS IN NUMERICAL ORDER TO YOUR CHILD’S SCHOOL (CVHS, REV or RHS) ATHLETIC OFFICE.

1

REDLANDS UNIFIED ATHLETICS BUILDING CHARACTER, CLASS AND CONFIDENCE

Teacher/Coach____________________________________________

REDLANDS UNIFIED SCHOOL DISTRICT

AUTHORIZATION TO CONSENT FOR TREATMENT OF MINOR We, the undersigned parents of: Minor or Minors ___________________________________________________________________________ Last Name First Name Birthdate Do hereby authorize any physician on the staff of a licensed hospital or emergency clinic, or any other physician designated by him (them) as agent(s) for the undersigned to consent to any X-Ray examination, anesthetic, medical or surgical diagnosis or treatment and hospital care which is deemed advisable by, and is to be rendered under the general or special supervision of any physician and surgeon on the staff of a licensed hospital or emergency clinic, whether such diagnosis or emergency treatment is rendered at the office of said physician or at said hospital(s). It is understood that this authorization is given in advance of any specific diagnosis, treatment or hospital care being required but is given to provide authority and power on the part of our aforesaid agent(s) to give specific consent to any and all such diagnosis, treatment, or hospital care which the aforementioned physician(s) in the exercise of his (their) best judgment may deem advisable. This authorization shall remain in effect for the ____________ school year or unless sooner revoked in writing and delivered to the school principal. This authorization is given pursuant to the provision of Section 25.8 of the Civil Code of California. Family Physician Physician’s Phone Number Health Insurance Company Group/Policy Number Signature of Father or Guardian Parent’s Address & Phone Number Signature of Mother or Guardian Parent’s Address & Phone Number Indicate Special Information Person to be notified in the event parents are unable to be reached: Name Address Phone Number

■■■ �Preparticipation�Physical�Evaluation��HISTORY�FORM

(Note: This form is to be filled out by the patient and parent prior to seeing the physician. The physician should keep this form in the chart.)

Date of Exam ___________________________________________________________________________________________________________________

Name __________________________________________________________________________________ Date of birth __________________________

Sex _______ Age __________ Grade _____________ School _____________________________ Sport(s) __________________________________

Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking

Do you have any allergies? Yes No If yes, please identify specific allergy below. Medicines Pollens Food Stinging Insects

Explain “Yes” answers below. Circle questions you don’t know the answers to.

GENERAL QUESTIONS Yes No

1. Has a doctor ever denied or restricted your participation in sports for any reason?

2. Do you have any ongoing medical conditions? If so, please identify below: Asthma Anemia Diabetes InfectionsOther: _______________________________________________

3. Have you ever spent the night in the hospital?

4. Have you ever had surgery?

HEART HEALTH QUESTIONS ABOUT YOU Yes No

5. Have you ever passed out or nearly passed out DURING or AFTER exercise?

6. Have you ever had discomfort, pain, tightness, or pressure in your chest during exercise?

7. Does your heart ever race or skip beats (irregular beats) during exercise?

8. Has a doctor ever told you that you have any heart problems? If so, check all that apply: High blood pressure A heart murmur High cholesterol A heart infection Kawasaki disease Other: _____________________

9. Has a doctor ever ordered a test for your heart? (For example, ECG/EKG, echocardiogram)

10. Do you get lightheaded or feel more short of breath than expected during exercise?

11. Have you ever had an unexplained seizure?

12. Do you get more tired or short of breath more quickly than your friends during exercise?

HEART HEALTH QUESTIONS ABOUT YOUR FAMILY Yes No

13. Has any family member or relative died of heart problems or had an unexpected or unexplained sudden death before age 50 (including drowning, unexplained car accident, or sudden infant death syndrome)?

14. Does anyone in your family have hypertrophic cardiomyopathy, Marfan syndrome, arrhythmogenic right ventricular cardiomyopathy, long QT syndrome, short QT syndrome, Brugada syndrome, or catecholaminergic polymorphic ventricular tachycardia?

15. Does anyone in your family have a heart problem, pacemaker, or implanted defibrillator?

16. Has anyone in your family had unexplained fainting, unexplained seizures, or near drowning?

BONE AND JOINT QUESTIONS Yes No

17. Have you ever had an injury to a bone, muscle, ligament, or tendon that caused you to miss a practice or a game?

18. Have you ever had any broken or fractured bones or dislocated joints?

19. Have you ever had an injury that required x-rays, MRI, CT scan, injections, therapy, a brace, a cast, or crutches?

20. Have you ever had a stress fracture?

21. Have you ever been told that you have or have you had an x-ray for neck instability or atlantoaxial instability? (Down syndrome or dwarfism)

22. Do you regularly use a brace, orthotics, or other assistive device?

23. Do you have a bone, muscle, or joint injury that bothers you?

24. Do any of your joints become painful, swollen, feel warm, or look red?

25. Do you have any history of juvenile arthritis or connective tissue disease?

MEDICAL QUESTIONS Yes No

26. Do you cough, wheeze, or have difficulty breathing during or after exercise?

27. Have you ever used an inhaler or taken asthma medicine?

28. Is there anyone in your family who has asthma?

29. Were you born without or are you missing a kidney, an eye, a testicle (males), your spleen, or any other organ?

30. Do you have groin pain or a painful bulge or hernia in the groin area?

31. Have you had infectious mononucleosis (mono) within the last month?

32. Do you have any rashes, pressure sores, or other skin problems?

33. Have you had a herpes or MRSA skin infection?

34. Have you ever had a head injury or concussion?

35. Have you ever had a hit or blow to the head that caused confusion, prolonged headache, or memory problems?

36. Do you have a history of seizure disorder?

37. Do you have headaches with exercise?

38. Have you ever had numbness, tingling, or weakness in your arms or legs after being hit or falling?

39. Have you ever been unable to move your arms or legs after being hit or falling?

40. Have you ever become ill while exercising in the heat?

41. Do you get frequent muscle cramps when exercising?

42. Do you or someone in your family have sickle cell trait or disease?

43. Have you had any problems with your eyes or vision?

44. Have you had any eye injuries?

45. Do you wear glasses or contact lenses?

46. Do you wear protective eyewear, such as goggles or a face shield?

47. Do you worry about your weight?

48. Are you trying to or has anyone recommended that you gain or lose weight?

49. Are you on a special diet or do you avoid certain types of foods?

50. Have you ever had an eating disorder?

51. Do you have any concerns that you would like to discuss with a doctor?

FEMALES ONLY

52. Have you ever had a menstrual period?

53. How old were you when you had your first menstrual period?

54. How many periods have you had in the last 12 months?

Explain “yes” answers here

I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.

Signature of athlete __________________________________________ Signature of parent/guardian ____________________________________________________________ Date _____________________

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.HE0503 9-2681/0410

■■■ �Preparticipation�Physical�Evaluation��PHYSICAL�EXAMINATION�FORM

Name __________________________________________________________________________________ Dateofbirth __________________________

PHYSICIAN REMINDERS1. Consideradditionalquestionsonmoresensitiveissues

•Doyoufeelstressedoutorunderalotofpressure?•Doyoueverfeelsad,hopeless,depressed,oranxious?•Doyoufeelsafeatyourhomeorresidence?•Haveyouevertriedcigarettes,chewingtobacco,snuff,ordip?•Duringthepast30days,didyouusechewingtobacco,snuff,ordip?•Doyoudrinkalcoholoruseanyotherdrugs?•Haveyouevertakenanabolicsteroidsorusedanyotherperformancesupplement?•Haveyouevertakenanysupplementstohelpyougainorloseweightorimproveyourperformance?•Doyouwearaseatbelt,useahelmet,andusecondoms?

2. Considerreviewingquestionsoncardiovascularsymptoms(questions5–14).

EXAMINATION

HeightWeight Male Female

BP/(/)PulseVisionR20/L20/Corrected Y N

MEDICAL NORMAL ABNORMAL FINDINGSAppearance• Marfanstigmata(kyphoscoliosis,high-archedpalate,pectusexcavatum,arachnodactyly,

armspan>height,hyperlaxity,myopia,MVP,aorticinsufficiency)Eyes/ears/nose/throat• Pupilsequal• HearingLymphnodesHearta

• Murmurs(auscultationstanding,supine,+/-Valsalva)• Locationofpointofmaximalimpulse(PMI)Pulses• SimultaneousfemoralandradialpulsesLungsAbdomenGenitourinary(malesonly)b

Skin• HSV,lesionssuggestiveofMRSA,tineacorporisNeurologicc

MUSCULOSKELETALNeckBackShoulder/armElbow/forearmWrist/hand/fingersHip/thighKneeLeg/ankleFoot/toesFunctional• Duck-walk,singleleghop

aConsiderECG,echocardiogram,andreferraltocardiologyforabnormalcardiachistoryorexam.bConsiderGUexamifinprivatesetting.Havingthirdpartypresentisrecommended.cConsidercognitiveevaluationorbaselineneuropsychiatrictestingifahistoryofsignificantconcussion.

 Clearedforallsportswithoutrestriction

 Clearedforallsportswithoutrestrictionwithrecommendationsforfurtherevaluationortreatmentfor _________________________________________________________________

____________________________________________________________________________________________________________________________________________

 Notcleared

 Pendingfurtherevaluation

 Foranysports

 Forcertainsports_____________________________________________________________________________________________________________________

Reason ___________________________________________________________________________________________________________________________

Recommendations _________________________________________________________________________________________________________________________________

________________________________________________________________________________________________________________________________________________

I have examined the above-named student and completed the preparticipation physical evaluation. The athlete does not present apparent clinical contraindications to practice and participate in the sport(s) as outlined above. A copy of the physical exam is on record in my office and can be made available to the school at the request of the parents. If condi-tions arise after the athlete has been cleared for participation, the physician may rescind the clearance until the problem is resolved and the potential consequences are completely explained to the athlete (and parents/guardians).

Nameofphysician(print/type)_____________________________________________________________________________________________________Date________________

Address___________________________________________________________________________________________________________Phone_________________________

Signatureofphysician_______________________________________________________________________________________________________________________,MDorDO

©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment.HE0503 9-2681/0410

Redlands Unified Athletics 4Concussion Information Sheet

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 5/20/2010

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

Redlands Unified Athletics 5Concussion Information Sheet

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 5/20/2010

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 its 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/ _____________________________ _____________________________ _____________ Student-athlete Name Printed Student-athlete Signature Date _____________________________ ______________________________ _____________ Parent or Legal Guardian Printed Parent or Legal Guardian Signature Date

6

ph Revised: 04/18/14

REDLANDS UNIFIED SCHOOL DISTRICT May 2014

Dear Parent or Guardian: Before your son or daughter is eligible to participate in interscholastic athletics and activities connected therewith, insurance coverage conforming to California Education Code Section 32220-32224 must be secured by you. This form is requesting the name of your medical insurance company. If none is available, you will need to purchase the school insurance made available through Myers/Stevens. The required coverage is for: Medical and Hospital Expenses in the amount of $1500. You may meet the above requirement in one of the two methods below. Please read the following carefully and check the appropriate box indicating the method you wish to use to meet these requirements.

1. I do hereby declare that my son/daughter is covered by insurance now carried by me that meets the medical and hospital expenses ($1500.00) _______________________________________ _____________________ (name of insurance company) (policy number)

2. I plan to purchase the required coverage from the Myers-Stevens Insurance Plan through my school. (This coverage meets all requirements of said Education Code Sections).

-Tackle Football Only – Grades 9-12 High Option Plan $338.00 -Tackle Football Only – Grades 9-12 Mid Option Plan 235.00 -Tackle Football Only – Grades 9-12 Low Option Plan 180.00 -24-Hour High Option Plan (covers non-tackle football/cheerleading activities) 317.00 -24-Hour Mid Option Plan (covers non-tackle football/cheerleading activities) 219.00 -24-Hour Low Option Plan (covers non-tackle football/cheerleading activities) 165.00 -School Time High Option Plan (covers non tackle football activities) 77.00 -School Time Mid Option Plan (covers non-tackle football activities) 63.00 -School Time Low Option Plan (covers non –tackle football activities) 39.00

IMPORTANT NOTE: REFER TO MYSERS-STEVENS ACCIDENT INSURANCE PAMPHLET FOR FURTHER DETAILS. WE STRONGLY RECOMMEND THE HIGH OPTION PLAN FOR STUDENTS PARTICIPATING IN INTERSCHOLASTIC SPORTS.

Under state law, school districts are required to ensure that all members of school athletic teams

have accidental injury insurance that covers medical and hospital expenses. The insurance

requirement can be met by the school district offering insurance or other health benefits that cover

medical and hospital expenses (Education code Section 32221.5). Some pupils may qualify to enroll in no-cost or low-cost local, state, or federally sponsored health

insurance programs. Information about these programs may be obtained by calling: (1) The Healthy Families Program: 1-800-880-5305; www.healthyfamilies.ca.gov (2) Medical: 1-800-541-5555 (3) Health Net 1-800-327-0502

I understand that the aforesaid law requires that the above coverage apply to members of athletic teams arising while such members are engaged in or preparing for an athletic event promoted under the sponsorship or arrangement of the school district or student body association, or while such members are being transported by or under the sponsorship of the school district or student body association to or from school or other place of the athletic event. I declare under penalty of perjury the above and foregoing is true and correct. ______________________________________________________________________________________ Signature of Parent/Guardian Name of son/daughter Date

REDLANDS UNIFIED ATHLETICS BUILDING CHARACTER, CLASS AND CONFIDENCE

REDLANDS UNIFIED SCHOOL DISTRICT 7CONSENT TO PARTICIPATE IN ATHLETICS/SPORTS ACTIVITIES

(Participation is Voluntary)

Name of School _____________________________________________ Date __________________________ Type of Athletic/Sport Activity ________________________________________________________________. Participation in the above athletic/sport activity is voluntary and is not required as a part of the regular school program. We hereby give our permission for our student________________________________________________, to participate in the above-described athletic/sport activity. We realize there is a possibility that a student may suffer severe injury, including permanent paralysis or death, as a result of participating in athletic or sports activities. In consideration of the permission granted, we, the undersigned, hereby release and discharge the Redlands Unified School District from all liability arising out of or in connection with the above described athletic/sport activity. In the event of an accident (or sudden illness), the school district has our permission to render whatever emergency medical treatment may be deemed necessary for the above named student. I understand and accept the responsibility for obtaining a written confirmation from the physician indicating that the student may return to practice and competition with an athletic team anytime a student is seen by such personnel. _________________ (please initial). Attendance and academic performance are essential for student success. This success provides the eligibility for participation in athletics. TO ENSURE THIS, STUDENTS MUST ATTEND ALL CLASSES ON THE DAY OF THE CONTEST OR THE DAY PRIOR TO A SATURDAY EVENT. Appointments on game days must follow the attendance policy as stated in the student handbook . __________ ( please initial) Transportation to and from most athletic contests will be provided by Redlands Unified School District. It is never permissible for students to transport other students to athletic contests. Students are expected to use this service as a representative of CVHS, REV or RHS. Any other arrangements due to emergency or family circumstances must be requested in writing by the parent/guardian (who has signed this form) the day before the trip and cleared through the Athletic Office. ____________ (please initial) IF THE STUDENT LIVES WITH BOTH PARENTS, IT IS NECESSARY FOR BOTH PARENTS TO SIGN. IF STUDENT LIVES WITH ONE PARENT, THAT PARENT MUST SIGN. _____________________________________ _____________________________________ Signature of Parent/Guardian Signature of Parent/Guardian _____________________________________ Signature of Student _________________________________________________ Health Insurance/Student Accident Insurance Carrier* *If you do not have accident insurance, the district provides forms for you to obtain insurance with Myers-Stevens Insurance Company. The forms are available at your school office.

PLEASE SIGN AND INITIAL ALL BLANK AREAS.

8 REDLANDS UNIFED SCHOOL DISTRICT ATHLETIC CLEARANCE INFORMATION

CIF ELIGIBILITY REQUIREMENT – RESIDENCE VERIFICATION

In order for us to determine CIF* and district eligibility to participate in athletics, we need to know with whom the student resides and what schools have been attended in the past 12 months. Please provide the following information: Name of Student_________________________________________________ Date_______________________ Currently Attending: □ CVHS □ REV □ RHS

Please check the appropriate box that applies to your student: □ My student is an incoming freshman. Name of Middle School _______________________________________ □ My student attended a Redlands Unified School District High School last year. Name of High School ________________________________________ □ My student attended one or more high schools last year.

Please list schools in order of attendance for the last 12 months: _________________________________________ _____________________________________________ ______________________________________________________ Name of Parent/Parents/Guardian student resided with last school year: ____________________________________________ Address of student last 12 months: _____________________________________________________________________________________________

1. I am the father of the above named student and he/she resides with me at: (Father’s address)_______________________________________________________________________________ _____________________________________________________________________________________________________ Father’s Name (Printed) Father’s Signature _____________________________________________________________________________________________________ Mother’s Name (Printed) Mother’s Signature

2. I am the mother of the above named student and he/she resides with me at: (Mother’s address)_____________________________________________________________________________________ 3. The above student does not reside with his/her parents. I am the guardian of this student and he/she resides with me at: _____________________________________________________________________________________________________ Address City Phone Number _____________________________________________________________________________________________________ Guardian’s Name (Printed) Guardian’s Signature

IF STUDENT LIVES WITH BOTH PARENTS, IT IS NECESSARY FOR BOTH PARENTS TO SIGN. IF STUDENT LIVES WITH ONE PARENT, THAT PARENT MUST SIGN.

*Falsifying Information (CIF Blue Book Rule #219): “Anyone associated with the student or the school who knowingly fail to provide complete and accurate information regarding eligibility to participate in athletics, shall result in the athlete being declared ineligible to represent their school in any sport for up to 24 months following the date of the discovery of the falsified information. The student(s) may be reinstated only by action of the Executive Committee.” mss – Revised 4/18/14

REDLANDS UNIFIED SCHOOL DISTRICT 9 6000 - INSTRUCTION BOARD POLICY 6145 - EXTRA-CURRICULAR AND CO-CURRICULAR ACTIVITIES ____ 1. The Governing Board recognizes that extra-curricular and co-curricular activities enrich the educational and social

development and experiences of students. The district shall encourage and support student participation in extra/co-curricular activities without compromising the integrity and purpose of the educational program.

2. No extracurricular or co-curricular program or activity shall be provided or conducted separately and no district student’s

participation in extracurricular and co-curricular activities shall be required or refused based on the student’s gender, sexual orientation, ethnic group identification, race, ancestry, national origin, religion color, or mental or physical disability. Requirements for participation in extracurricular and co-curricular activities shall be limited to those that are essential to the success of the activity. (5 CCR 4925)

3. Any complaint regarding the district’s extracurricular and co-curricular programs or activities shall be filed in accordance

with BP/AR 1312.3 – Uniform Complaint Procedures. (cf. 0410 – Nondiscrimination In District Programs And Activities) (cf. 1312.3 – Uniform Complaint Procedures) (cf. 5145.3 – Nondiscrimination/Harassment) (cf. 5145.7 – Sexual Harassment) 4. All students in grades six through 12 who participate in extra/co-curricular activities sponsored by the school(s) in the

Redlands Unified School District shall be required to meet the minimum academic standards as specified in this policy. 5. This policy does not preclude other school-sponsored organizations from requiring a higher eligibility standard. 6. Extra/co-curricular activities shall be defined as officially recognized, organized and school sponsored athletic and

performing group programs which extend beyond the regular school day or outside of regular classroom activities. The activities shall include performing band and auxiliary units, chorus(es), athletic teams and pep units, and speech and drama groups.

7. No student shall be prohibited from participating in extra/co-curricular activities related to the educational program because

of inability to pay fees associated with the activity. 8. The superintendent/designee shall ensure that disabled students have access, to the extent possible, to extra-curricular and

co-curricular activities, student organizations and school-related social events. (cf. 0410 – Nondiscrimination in District Programs and Activities) 9. Extra/co-curricular activities shall be supervised by district employees whenever they are conducted under the name of the

district. (cf. 4127/4227/4327 – Temporary Athletic Team Coaches) 10. Eligibility Requirements

a. In order to participate in extra/co-curricular activities, students in grades 6 through 12 must demonstrate satisfactory educational progress the previous grading period including but not limited to: (Education Code 35160.5)

i. Maintenance of a minimum of 2.0 grade point average on a 4.0 scale

ii. Maintenance of minimum progress toward meeting high school graduation requirements (cf. 6146.1 – High School Graduation Requirements/Proficiency) (cf. 6162.52 – High School Exit Examination)

b. Satisfactory educational progress shall include, but not be limited to the following:

(i) Student must be enrolled in and pass at least four semester classes or the equivalent of twenty (20) semester hours and maintain a “C” average on a 4-point scale.

REDLANDS UNIFIED SCHOOL DISTRICT 10 6000 - INSTRUCTION EXTRA-CURRICULAR AND CO-CURRICULAR ACTIVITIES Page 2 BP 6145

(ii) Grades shall be counted in the following manner: A=4 points, B=3 points, C=2 points, D=1 point, and F=0 points.

(iii) No additional points may be counted for plus (+) or minus (-) grades. (iv) In Pass – Fail classes a pass grade shall be counted as a “C” grade for the purpose of determining

eligibility.

(v) Incomplete grades shall not be counted in determining eligibility unless the class constitutes part of the twenty [20] semester units needed for eligibility. In the event the incomplete grade is in part of the twenty [20] semester units, the incomplete grade shall be counted as an “F”.

c. The determination of student eligibility shall be made at the time of the distribution of the official quarterly

progress reports and semester report cards. Eligibility must be reestablished for each of the four grading periods during the school year. In the event a student finds that he/she is academically ineligible to participate in co-curricular activities for the upcoming school year, he/she may request in writing that current summer school grades be used to determine eligibility for the first grading period for the upcoming school year.

d. Each student shall be entitled to petition for a one-time waiver of the eligibility requirements at the beginning of

his/her ninth [9th] grade year. The principal/designee shall determine if a waiver is to be granted; and, if granted, an academic remediation and assistance plan shall be developed to ensure continued eligibility.

Legal Reference: EDUCATION CODE 35145 PUBLIC MEETINGS 35160.5 District Policy Rules and Regulations; Requirements; Matters Subject to Regulation 35179 Interscholastic Athletics; Associations or Consortia 48930-48938 Student Organizations CODE OF REGULATIONS, TITLE 5 350 Fees not Permitted 4900-4965 NONDISCRIMINATION IN ELEMENTARY AND SECONDARY EDUCATION PROGRAMS RECEIVING

STATE FINANCIAL ASSISTANCE 5531 Supervision of Extracurricular Activities of Pupils UNITED STATES CODE, TITLE 42 2000h-2-2000h-6 TITLE IX, 1972 EDUCATION ACT AMENDMENTS COURT DECISIONS Hartzell v. Connell, (1984) 35 cal. 3D 899 Management Resources: CDE LEGAL ADVISORY 001.90 Access to School-Related Activities and Events by Disabled Students, LO: 3-90 0409.87 Requirements for Pupil Participation in Extra-Curricular and Co-curricular Activities, AB 2613, CIL: 86/87-11 WEB SITES CALIFORNIA ASSOCIATION OF DIRECTORS OF ACTIVITIES: http://www.cadal.org Originating Office: Educational Services Division Effective Date: June 27, 1995 Revision Date: December 7, 1999 March 14, 2006 __________________________________________________ _____________________ (Parent/Guardian Signature) (Date)

11 10932 Pine Street Telephone: 562-493-9500 Los Alamitos, California 90720 Fax: 562-493-6266

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 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 the (school/school district name) policy regarding the use of illegal drugs will be enforced for any violations of these rules. Printed Name of Student Athlete Signature of Student Athlete Date Signature of Parent/Caregiver Date A copy of this form must be kept on file in the athletic director’s office at the local high school on an annual basis and the Principal’s Statement of Compliance must be on file at the CIF Southern Section office.

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REDLANDS UNIFIED ATHLETICS BUILDING CHARACTER, CLASS AND CONFIDENCE

REDLANDS UNIFIED SCHOOL DISTRICT 12 ATHLETIC DEPARTMENT

STUDENT-ATHLETE CODE OF CONDUCT Interscholastic athletic competition should demonstrate high standards of ethics and sportsmanship and promote the development of good character and other important life skills. The highest potential of sports is achieved when participants are committed to “Pursuing Victory with Honor” according to six core principles of trustworthiness, respect, responsibility, fairness, caring and good citizenship (the “Six Pillars of Character…”). This Code applies to all student-athletes involved in interscholastic sports in California. I understand that, in order to participate in high school athletics, I must act in accord with the following:

TRUSTWORTHINESS 1. Trustworthiness – to be worthy of trust in all I do.

• Integrity – live up to high ideals of ethics and sportsmanship and always pursue victory with honor, do what’s right even when it’s unpopular or personally costly.

• Honesty – live and compete honorably, don’t lie, cheat, steal or engage in any other dishonest or unsportsmanlike conduct.

• Reliability – fulfill commitments; do what I say I will do; be on time to practices and games.

• Loyalty – be loyal to my school and team; put the team above my personal glory.

RESPECT 2. Respect – treat all people with respect all the

time and require the same of other student-athletes.

3. Class – live and play with class, be a good sport, be gracious in victory and accept defeat with dignity; give fallen opponents help, compliment extraordinary performance, show sincere respect in pre-and post-game rituals.

4. Disrespectful Conduct – don’t engage in disrespectful conduct of any sort including profanity, obscene gestures, offensive remarks of a sexual or racial nature, trash talking, taunting, boastful celebrations, or other actions that demean individuals or the sport.

5. Respect Officials – treat contest officials with respect, don’t complain about or argue with official calls or decisions during or after an athletic event.

RESPONSIBILITY 6. Importance of Education – be a student first

and commit to getting the best education I can. Be honest with myself about the likelihood of getting an athletic scholarship or playing on a professional level and remember that many universities will not recruit student-athletes that do not have a serious commitment to their education, the ability to succeed academically or the character to represent their institution honorably.

7. Role Modeling – remember, participation in sports is a privilege, not a right and that I am expected to represent my school, coach and teammates with honor, on and off the field. Consistently exhibit good character and conduct yourself as a positive role model. Suspension or termination of this privilege is within the sole discretion of the school administration.

8. Self-control – exercise self-control; don’t fight or show excessive displays of anger or frustration; have the strength to overcome the temptation to retaliate.

9. Healthy lifestyle – safeguard your health; don’t use any illegal or unhealthy substances including alcohol, tobacco and drugs or engage in any unhealthy techniques to gain or lose or maintain weight.

10. Integrity of the Game – protect the integrity of the game – don’t gamble. Play the game according to the rules.

FAIRNESS 11. Be fair – live up to high standards of fair play, be

open-minded; always be willing to listen and learn.

CARING 12. Concern for others – demonstrate concern for

others; never intentionally injure any player or engage in reckless behavior that might cause injury to myself or others.

13. Teammates – help promote the well being of teammates by positive counseling and encouragement or by reporting any unhealthy or dangerous conduct to coaches.

CITIZENSHIP 14. Play by the rules – maintain a thorough

knowledge of and abide by all applicable game and competition rules.

15. Spirit of rules – honor the spirit and the letter of rules; avoid temptations to gain competitive advantage through improper gamesmanship techniques that violate the highest traditions of sportsmanship.

I have read and understand the requirements of this Code of Conduct. I understand that I’m expected to perform according to this code and I understand that there may be sanctions or penalties if I do not. Student-Athlete Signature ________________________________ Parent/Guardian Signature ________________________________

Redlands Unified Athletics Building Character, Class and Confidence

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Redlands Unified School District Educational Services Division

Student Services Department P.O. Box 3008 Redlands, California 92373-1508 (909) 307-5300 FAX (909) 792-3847

Parent Code of Conduct

Parental support of our athletic team is vital, and greatly appreciated. In order to provide a positive climate for coaches and players to do their best, eliminate distractions that might negatively impact the program, model good sportsmanship, and comply with CIF Rules, we are asking for your support of the following Parental Code of Conduct. We strongly encourage your active, positive support of your child, and look forward to your attendance at the games and other sponsored activities. The concept of sportsmanship, however, must be taught, modeled and reinforced by adults. The parents/guardians of athletes must maintain self-control and demonstrate proper perspective as it relates to winning and losing. It is important to remember that an athletic contest is ONLY A GAME – NOT A MATTER OF LIFE AND DEATH. Accordingly, we are asking all parents/guardians, and spectators who attend games to abide by the following:

• Please show respect for others by refraining from booing or shouting/yelling derogatory comments or remarks from the stands towards our opponents, coaches or officials. Personal insults or abusive, foul language will not be tolerated. Violations may result in penalties against the team and ejection of the offender.

• Parents shall not confront or seek to conference with coaches or officials during or

immediately after games, except in cases of injuries or emergency medical treatment for their child.

• Conferences with the Coach to discuss or critique their game preparation, coaching

strategy, or the status of other players will not be held. Any conference to discuss your child’s status must be scheduled with the Coach in advance.

• Other forms of behavior that are disruptive to the game or others’ enjoyment of the game

will not be allowed. This includes, but is not limited to, approaching the bench area while the game is in progress, or attempting to coach your child or direct other players during games or practice.

• Be supportive of your child’s efforts and the efforts of his/her teammates – be

encouraging rather than negative regardless of the outcome of a game.

• If there is a change of address for the student, the parent/guardian shall inform the counseling/athletic office immediately.

_______________________________ _____________________________ Parent/Guardian Signature Date Parent/Guardian Signature Date

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Division I 16 Core Classes

Division II 16 Core Classes

Divisions I and II Initial-Eligibility Requirements

For All RUSD Student-Athletes desiring to play collegiate athletics at the Division I or Division II level, it is imperative you are aware of the following eligibility requirements set forth by the NCAA Eligibility Center (web1.ncaa.org) Core Courses

NCAA Division I requires 16 core courses. NCAA Division II currently requires 14 core courses. Division II will require 16 core courses for students enrolling on or after August 1, 2013. See the charts below.

NCAA Division I will require 10 core courses to be completed prior to the seventh semester (seven of the 10 must be a combination of English, math or natural or physical science that meet the distribution requirements below). These 10 courses become "locked in" at the seventh semester and cannot be retaken for grade improvement. o Beginning August 1, 2016, it will be possible for a Division I college-bound student-athlete to still receive

athletics aid and the ability to practice with the team if he or she fails to meet the 10 course requirement, but would not be able to compete.

Test Scores Division I uses a sliding scale to match test scores and core grade-point averages (GPA). The sliding scale for

those requirements is shown on Page No. 2 of this sheet. Division II requires a minimum SAT score of 820 or an ACT sum score of 68.

The SAT score used for NCAA purposes includes only the critical reading and math sections. The writing section of the SAT is not used.

The ACT score used for NCAA purposes is a sum of the following four sections: English, mathematics, reading and science.

When you register for the SAT or ACT, use the NCAA Eligibility Center code of 9999 to ensure all SAT and ACT scores are reported directly to the NCAA Eligibility Center from the testing agency. Test scores that appear on transcripts will not be used.

Grade-Point Average Be sure to look at your high school’s List of NCAA Courses on the NCAA Eligibility Center's website

(www.eligibilitycenter.org). Only courses that appear on your school's List of NCAA Courses will be used in the calculation of the core GPA. Use the list as a guide.

Division I students enrolling full time before August 1, 2016, should use Sliding Scale A to determine eligibility to receive athletics aid, practice and competition during the first year.

Division I GPA required to receive athletics aid and practice on or after August 1, 2016, is 2.000 (corresponding test-score requirements are listed on Sliding Scale B on Page No. 2 of this sheet).

Division I GPA required to be eligible for competition on or after August 1, 2016, is 2.300 (corresponding test-score requirements are listed on Sliding Scale B on Page No. 2 of this sheet).

The Division II core GPA requirement is a minimum of 2.000.

Remember, the NCAA GPA is calculated using NCAA core courses only.

4 years of English. 3 years of mathematics (Algebra I

or higher).

2 years of natural/physical science (1 year of lab if offered by high school).

1 year of additional English, mathematics or natural/physical science.

2 years of social science.

4 years of additional courses (from any area above, foreign language or comparative religion/philosophy).

(2013 and after)

3 years of English. 2 years of mathematics (Algebra I or

higher).

2 years of natural/physical science (1 year of lab if offered by high school).

3 years of additional English, mathematics or natural/physical science.

2 years of social science. 4 years of additional courses (from

any area above, foreign language or comparative religion/philosophy).

By signing below I am aware that there are “Initial Eligibility Requirements” that must be met in order to

compete at the NCAA Division I & II level. More information can be found at http://web1.ncaa.org.

Parent Signature:_______________ Date:_______ Student Signature:________________ Date:________

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Sliding Scale A Use for Division I prior to August 1, 2016 NCAA DIVISION I SLIDING SCALE Core GPA SAT ACT

Verbal and Math ONLY 3.550 & above 400 37 3.525 410 38 3.500 420 39 3.475 430 40 3.450 440 41 3.425 450 41 3.400 460 42 3.375 470 42 3.350 480 43 3.325 490 44 3.300 500 44 3.275 510 45 3.250 520 46 3.225 530 46 3.200 540 47 3.175 550 47 3.150 560 48 3.125 570 49 3.100 580 49 3.075 590 50 3.050 600 50 3.025 610 51 3.000 620 52 2.975 630 52 2.950 640 53 2.925 650 53 2.900 660 54 2.875 670 55 2.850 680 56 2.825 690 56 2.800 700 57 2.775 710 58 2.750 720 59 2.725 730 59 2.700 730 60 2.675 740-750 61 2.650 760 62 2.625 770 63 2.600 780 64 2.575 790 65 2.550 800 66 2.525 810 67 2.500 820 68 2.475 830 69 2.450 840-850 70 2.425 860 70 2.400 860 71 2.375 870 72 2.350 880 73 2.325 890 74 2.300 900 75 2.275 910 76 2.250 920 77 2.225 930 78 2.200 940 79 2.175 950 80 2.150 960 80 2.125 960 81 2.100 970 82 2.075 980 83 2.050 990 84 2.025 1000 85 2.000 1010 86

Sliding Scale B Use for Division I beginning August 1, 2016 NCAA DIVISION I SLIDING SCALE GPA

for Aid and Practice GPA

for Competition SAT ACT Sum

3.550 4.000 400 37 3.525 3.975 410 38 3.500 3.950 420 39 3.475 3.925 430 40 3.450 3.900 440 41 3.425 3.875 450 41 3.400 3.850 460 42 3.375 3.825 470 42 3.350 3.800 480 43 3.325 3.775 490 44 3.300 3.750 500 44 3.275 3.725 510 45 3.250 3.700 520 46 3.225 3.675 530 46 3.200 3.650 540 47 3.175 3.625 550 47 3.150 3.600 560 48 3.125 3.575 570 49 3.100 3.550 580 49 3.075 3.525 590 50 3.050 3.500 600 50 3.025 3.475 610 51 3.000 3.450 620 52 2.975 3.425 630 52 2.950 3.400 640 53 2.925 3.375 650 53 2.900 3.350 660 54 2.875 3.325 670 55 2.850 3.300 680 56 2.825 3.275 690 56 2.800 3.250 700 57 2.775 3.225 710 58 2.750 3.200 720 59 2.725 3.175 730 60 2.700 3.150 740 61 2.675 3.125 750 61 2.650 3.100 760 62 2.625 3.075 770 63 2.600 3.050 780 64 2.575 3.025 790 65 2.550 3.000 800 66 2.525 2.975 810 67 2.500 2.950 820 68 2.475 2.925 830 69 2.450 2.900 840 70 2.425 2.875 850 70 2.400 2.850 860 71 2.375 2.825 870 72 2.350 2.800 880 73 2.325 2.775 890 74 2.300 2.750 900 75 2.275 2.725 910 76 2.250 2.700 920 77 2.225 2.675 930 78 2.200 2.650 940 79 2.175 2.625 950 80 2.150 2.600 960 81 2.125 2.575 970 82 2.100 2.550 980 83 2.075 2.525 990 84 2.050 2.500 1000 85 2.025 2.475 1010 86 2.000 2.450 1020 86

2.425 1030 87 2.400 1040 88 2.375 1050 89 2.350 1060 90 2.325 1070 91 2.300 1080 93