The student's email address listed here must be their @rockyhillps.com email account. Coaches and teachers must be able to communicate via email through the student's school email account.

You have my permission to take whatever action is deemed necessary for the health and welfare of my child.

I agree to notify the Athletic Director immediately if my child develops an illness or injury during the season, which would affect his/her ability to participate in any practices or contests.

Click here to view the Middle School Athletics Handbook.

Click here to view the High School Athletics Handbook.

I hereby acknowledge I have read the Athletic Handbook explaining the following:

• Eligibility
• Physicals
• Standards for Practice/Games
• Substance Abuse Policies/Procedures
• Insurance for Athletes
• Performance Enhancing Drug Policy
• Sportsmanship
• General Policies/Procedures
• Awards
• Equipment and Uniforms
• Athletic Team Attendance Policies

I agree to adhere to these regulations while participating in athletics at Rocky Hill Public Schools.

My agreement below indicates that I have visited the Concussion Central page on the CIAC website and have viewed the Connecticut Task Force video on concussions. I have also read and agree to adhere by the standards and protocols put in place by The Moser School, and understand that my child will not be permitted to return to athletic competition until they have met all criteria contained within.

My agreement below indicates that I have visited the Concussion Central page on the CIAC website and have viewed the Connecticut Task Force video on concussions. I have also read and agree to adhere by the standards and protocols put in place by Rocky Hill High School, and understand that my child will not be permitted to return to athletic competition until they have met all criteria contained within.

My agreement below indicates that I have visited the Concussion Central page on the CIAC website and have viewed the Connecticut Task Force video on concussions. I have also read and agree to adhere by the standards and protocols put in place by Albert D. Griswold Middle School, and understand that my child will not be permitted to return to athletic competition until they have met all criteria contained within.

I understand that such activity involves the potential for injury which is inherent in all sports. Even with the best coaching, use of the most protective equipment, and strict observance of rules, injuries are still a possibility. On rare occasions, these injuries can be so severe as to result in total disability, paralysis or even death.

I give my permission to the appropriate certified school staff or medical personnel to render emergency treatment, if required, when associated with an athletic injury or illness.

I agree not to hold the school or anyone acting on its behalf responsible for any injury occurring to the student in the course of such athletic activities or travel.

NOTE:  This document was developed to provide student-athletes and parents/guardians with current and relevant information regarding sudden cardiac arrest.  A new form is required to be read, signed, dated and kept on file by the student-athlete’s associated school district annually to comply with Connecticut General Statutes Chapter 163, Section 10-149f: SUDDEN CARDIAC ARREST AWARENESS EDUCATION PROGRAM.

Part I – SUDDEN CARDIAC ARREST - 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 doesn’t just happen to adults; it takes the lives of students, too. However, the causes of sudden cardiac arrest in students and adults can be different. A student’s SCA will likely result from an inherited condition, while an adult’s SCA may be caused by either inherited or lifestyle issues. SCA is NOT a heart attack. A heart attack may cause SCA, but they are not the same. A heart attack is caused by a blockage that stops the flow of blood to the heart. SCA is a malfunction in the heart’s electrical system, causing the heart to suddenly stop beating.

PART II - HOW COMMON IS SUDDEN CARDIAC ARREST IN THE UNITED STATES?

SCA is the #1 cause of death for adults in this country. There are about 300,000 cardiac arrests outside hospitals each year. It is a leading cause of death for student athletes.

According to an April 2014 study for PubMed the incidence was 

• 0.63 per 100,000 in all students (6 in one million)
• 1.14 per 100,000 athletes  (10 in one million)
• 0.31 per student non-athletes  (3 in one million)
• The relative risk of SCA in student athletes vs non-athletes was 0.65
• There is a significantly higher risk of SCA for boys than girls

Leading causes of sudden death among high school and college athletes, according to the National Collegiate Athletic Association (NCAA) (on CBS News, June 28, 2012)* are heat stroke, heart disease and traits associated with sickle cell anemia.  Prevention of sudden death, the same study concludes, is associated with more advanced cardiac screening with attention to medical histories and birth records, improved emergency procedures, and good coaching and conditioning practices.  SCA can be prevented if the underlying causes can be diagnosed and treated.

PART III - WHAT ARE THE WARNING SIGNS AND SYMPTOMS?

Although SCA happens unexpectedly, some people may have signs or symptoms, such as: fainting or seizures during exercise; unexplained shortness of breath; dizziness; extreme fatigue; chest pains; or racing heart.

These symptoms can be unclear in athletes, since people often confuse these warning signs with physical exhaustion.

Sudden cardiac arrest is a medical emergency. If not treated immediately, it causes sudden cardiac death. With fast, appropriate medical care, survival is possible. Administering cardiopulmonary resuscitation (CPR) — or even just compressions to the chest — can improve the chances of survival until emergency personnel arrive.

WHAT ARE THE RISKS OF PRACTICING OR PLAYING AFTER EXPERIENCING THESE SYMPTOMS?

There are risks associated with continuing to practice or play after experiencing these symptoms. When the heart stops, so does the blood that flows to the brain and other vital organs. Death or permanent brain damage can occur in just a few minutes. Most people who experience SCA die from it.

REMOVAL FROM PLAY

Any student-athlete who shows signs or symptoms of SCA must be removed from athletic activity and referred to a licensed health care professional trained specifically in the treatment of cardiac care. The symptoms can happen before, during or after activity.

RETURN TO PLAY
Before returning to play, the athlete must be evaluated. Clearance to return to play must be in writing. The evaluation must be performed and written clearance be provided by a licensed medical provider.

To summarize:

• SCA is, by definition, sudden and unexpected.
• SCA can happen in individuals who appear healthy and have no known heart disease.
• Most people who have SCA die from it, usually within minutes.
• Rapid treatment of SCA with a defibrillator can be lifesaving.
• Training in recognition of signs of cardiac arrest and SCA, and the availability of AEDs and personnel who possess the skills to use one, may save the life of someone who has had an SCA.

(National Heart, Lung, and Blood Institute) 

      Sources:

Connecticut Association of Athletic Directors - http://caadinc.org/resources.html

Please watch the Connecticut Concussion Task Force Video.

Please read the Concussion and Cardiac Arrest Information Sheet. 

I give my permission for this student to have pre- and post-concussion ImPACT  (Immediate Post-concussion Assessment and Cognitive Testing) testing administered at The Moser School.  I understand that my child may need to be tested more than once, after comparing the post-concussion test results with my child’s original baseline test.   I am aware that there is no charge for this testing.

The Moser School may release the results of the ImPACT ® testing to my child’s primary care physician, neurologist, or other attending physician indicated below.

I understand that some general test result data and information may be provided to my child’s Guidance Counselor and Teachers, in order to develop temporary academic modifications.

I give my permission for this student to have pre- and post-concussion ImPACT  (Immediate Post-concussion Assessment and Cognitive Testing) testing administered at Rocky Hill High School.  I understand that my child may need to be tested more than once, after comparing the post-concussion test results with my child’s original baseline test.   I am aware that there is no charge for this testing.

Rocky Hill High School may release the results of the ImPACT ® testing to my child’s primary care physician, neurologist, or other attending physician indicated below.

I understand that some general test result data and information may be provided to my child’s Guidance Counselor and Teachers, in order to develop temporary academic modifications.

I give my permission for this student to have pre- and post-concussion ImPACT  (Immediate Post-concussion Assessment and Cognitive Testing) testing administered at Albert D. Griswold Middle School.  I understand that my child may need to be tested more than once, after comparing the post-concussion test results with my child’s original baseline test.   I am aware that there is no charge for this testing.

Albert D. Griswold Middle School may release the results of the ImPACT ® testing to my child’s primary care physician, neurologist, or other attending physician indicated below.

I understand that some general test result data and information may be provided to my child’s Guidance Counselor and Teachers, in order to develop temporary academic modifications.

Please read the Consent to Treat. 

Please read the Exertional Heat Illness Program and Annual Review and enter the parent/guardian's signature and student's signature below. 

The electronic signature below and its related fields are treated by Rocky Hill Public Schools like a handwritten signature on a paper form.

I affirm that all the information provided is true and correct to the best of my knowledge.