TO PARENTS AND ATHLETES:

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1 McAlester Public School 301 E. Adams John Homer McAlester, OK Randy Hughes Athletic Director Superintendent TO PARENTS AND ATHLETES: BEFORE AN ATHLETE CAN PRACTICE OR PARTICIPATE IN ANY ATHLETIC ACTIVITY, THE ATTACHED FORMS MUST BE FILLED OUT CORRECTLY AND SIGNED. LISTED BELOW ARE THE ATTACHED FORMS. OSSAA PREPARTICIPATION PHYSICAL EVALUATION OSSAA PHYSICAL EXAMINATION AND PARENTAL CONSENT FORM OSSAA ELIGIBILITY RECORD FORM INSURANCE VERIFICATION FORM STUDENT ATHLETE DRUG TESTING CONSENT FORM CONCUSSION AND HEAD INJURY ACKNOWLEDGEMENT CARDIAC ARREST ACKNOWLEDGEMENT MCALESTER PUBLIC SCHOOLS RELEASE FOR MEDICAL TREATMENT ALL FORMS MUST BE SIGNED AND RETURNED TO YOUR COACH OR ATHLETIC DEPARTMENT BEFORE THE FIRST DAY OF ORGANIZED PRACTICE.

6 INSURANCE VERIFICATION FORM Although the McAlester Public School System assumes NO financial responsibility for the cost of any accident occurring to an athlete while participating in a sport or at the school, a special accident insurance policy is available should you wish to purchase it. The insurance is offered for your convenience and neither the school nor any school official is compensated in any way by the insurance company. Please read the insurance brochure for an explanation of what will be paid and retain the brochure for future reference. In order for a student to participate in athletics, he/she should have accident insurance or return this form indication that student insurance is not needed. Indicate which option you have selected by checking the appropriate box. ( ) $ is enclosed to purchase the student insurance. ( ) We have adequate insurance and do not with to participate. Insurance Company Address Policy Number Student s Name Parent s Name

7 SPORT GRADE McAlester Public School District Student Athlete Drug Testing Consent Statement of Purpose and Intent Participation in school sponsored interscholastic sports at the McAlester School District is a privilege. Student athletes carry a responsibility to themselves, their fellow students, their parents, and their school to set the highest possible examples of conduct, which includes avoiding the use or possession of illegal drugs. Drug use of any kind is incompatible with participation in extra-curricular athletics on behalf of the McAlester Public School District. For the safety, health and well being of the student athletes of the McAlester Public School District, the McAlester Public School District has adopted the attached Student Athlete Drug Testing Policy and this Student Athlete Drug Testing Consent for use by all participating student athletes at the middle school and high school levels. Participation in Extra-Curricular Athletics Each student athlete shall be provided with a copy of the Student Athlete Drug Testing Policy and Student Athlete Drug Testing Consent which shall be read, signed and dated by the student athlete, parent or custodial guardian, and coach/sponsor before such student athlete shall be eligible to practice or participate in any extra-curricular athletics. The consent shall be to provide a urine sample: a) as part of their annual physical, b) as chosen by the ransom selection basis, and c) at any time requested based on reasonable suspicion to be tested for illegal or performance-enhancing drugs. No student shall be allowed to practice or participate in any extra-curricular athletics unless the student has returned the properly signed Student Athlete Drug Testing Consent. Student s Last Name First Name MI I understand after having read the Student Athlete Drug Testing Policy and Student Athlete Drug Testing Consent that, out of care for my safety and health, the McAlester Public School District enforces the rules applying to the consumption or possession of illegal and performance-enhancing drugs. As a member of a McAlester athletic team, I realize that the personal decision that I make daily in regard to the consumption or possession of illegal or performance-enhancing drugs may affect my health and well-being as well as the possible endangerment of those around me and reflect upon any organization with which I am associated. If I choose to violate school policy regarding the use of possession of illegal or performance-enhancing drugs any time while I am involved in in-season or off-season athletics, I understand upon determination of that violation I will be subject to the restrictions of my participation as outlined in the Policy. Signature of Student Date We have read and understand the McAlester Public School District Student Athlete Drug Testing Policy and Student Athlete Drug Testing Consent. We desire that the student named above participate in the Interscholastic sports programs of the McAlester Public School District, and we hereby voluntarily agree to be subject to its terms. We accept the method of obtaining urine samples, testing and analysis of such specimens, and all other aspects of the program. We further agree and consent to the disclosure of the sampling, testing and results as provided in this program. Signature of Parent or Custodial Guardian Signature of Coach Date Team Medication List (This medication list may be submitted to the lab in a sealed and confidential envelope) I,, am currently taking or have taken the following drugs, substances, or medications in the last 96 hours (4 days):

8 Concussion and Head Injury Acknowledgement McAlester Public School In compliance with Oklahoma Statute Section of Title 70, this acknowledgement form is to confirm that you have read and understand the CONCUSSION FACT SHEET provided to you by McAlester Public School related to potential concussions and head injuries occurring during participation in athletics. I,, as a student-athlete who participates in McAlester Public School athletics and I, as the parent/legal guardian, have read the information material provided to us by McAlester Public School related to concussions and head injuries occurring during participation in athletics programs and understand the content and warnings. SIGNATURE OF STUDENT-ATHLETE DATE SIGNATURE OF PARENT/LEGAL GUARDIAN DATE This form should be completed annually prior to the athlete s first practice and/or competition and be kept on file for one year beyond the date of signature in the principal s office or the office designated by the principal.

9 Athlete/Parent/Gaurdian Sudden Cardiac Arrest Symptoms and Warning Signs (NAME OF SCHOOL) I have reviewed the Athlete/Parent/Guardian Sudden Cardiac Arrest Symptons (SCA) and Warning Signs informational material jointly developed by Oklahoma State Department of Health and the Oklahoma State Department of Education and understand the symptoms and warning signs of SCA related to participation in athletic programs. Signature of Student-Athlete Print Student-Athlete s Name Date Signature of Parent/Guardian Print Parent/Guardian s Name Date This form is required to be completed annually prior to the athlete s first practice and/or competition and be kept on file for one year beyond the date of signature in the principal s office or the office designated by the principal. OK State Department of Health and OK State Department of Education : Sudden Cardiac Arrest Symptoms and Warning Signs Information Sheet and Acknowledgement of Receipt and Review Form. 7/1/2015

10 Medical Release on back Please Sign

11 MCALESTER PUBLIC SCHOOLS RELEASE FOR MEDICAL TREATMENT Name Birth date I (We) parent(s), legal guardian of,, hereby give consent to provide him / her with emergency medical care for accidents and / or illness during the school year. I (We) also give permission to transport my child to and from locations where health services are provided. I authorize the McAlester Public Schools to transport my son or daughter to all approved athletic activities. Signed: Parent or Legal Guardian Emergency Phone # 1 Emergency Phone # 2

Student Drug & Alcohol Testing Policy for Extracurricular Activities

Student Drug & Alcohol Testing Policy for Extracurricular Activities The Geary Board of Education, in an effort to protect the health and safety of its students from illegal drug and/or alcohol use and