Jr. Laser Football Registration - Kettle Moraine School District

KETTLE MORAINE SCHOOL DISTRICT
COMMUNITY EDUCATION OFFICE
349 North Oak Crest Drive, Wales, WI 53183
P: 262-968-6273 ext.4252 F: 262-968-6217
W: www.kmsd.edu/communityed
February, 2016
Dear Parents and Legal Guardians of prospective Junior Laser Football Players:
The Kettle Moraine Junior Laser Football Program (KMJLF) is accepting registrations for the 2016 fall
football season. Junior Laser Football will offer 5,6,7, and 8th grade competitive tackle football. The
numbers of teams per grade will depend on the registration numbers. The teams will play a 7 game
schedule on Saturdays in the fall.
The participants are expected to be in attendance at all practices and games. Prior communication with
coaches is necessary to excuse absences. Registration Deadline – March 8- Registrations received
after March 8 will be assessed a $50 late fee and placed on a wait list. *** DEADLINE EXTENDED TO
3/30/16 PER THE WAUKESHA YOUTH FOOTBALL LEAGUE
There will be an informational meeting for those new to the program or those considering registering to
learn more about our program and answer any questions. The meeting will take place on Wednesday,
March 2 at 7pm in the high school library.
Please mail the completed registration packet along with the required registration fee to the address
listed below:
Kettle Moraine Community Education
349 N. Oak Crest Drive
Wales WI 53183
A signed physical card must be on file with Community Education before any player can begin practice
August 1. This is not due at registration but must be turned in by August 1. The form is included with
the registration for your convenience or can be found at www.kmjlf.org under handouts. KMJLF
supplies all equipment necessary to participate in the football program with the exception of shoes,
socks, practice gear (player pack) and mouth guard. Players with special dental work or braces should
check with their dentists about mouth guards. All players must be covered under their family’s health
insurance. By signing the Registration Form, the legal guardian(s) accept responsibility for primary
insurance covering any and all medical bills resulting from football activities.
- Learning Without Boundaries –
Page 2
Registration will take place by mail. The cost is $250 per player. You will also be responsible to purchase
the practice player pack, for approximately $50 at our June informational meeting. Half of the
registration Fee ($125.00) is due with the Registration Forms no later than March 8, and the second half
($125.00) is due July 1. A $25 discount per player is offered to families with multiple players in the
program. If not paid by July 1, players will not receive equipment. Please make checks payable to KM
Community Education. If you have any questions, please contact the office at 262-968-6273 ext. 4252.
Families are required to volunteer during the season. This program cannot run without your support.
Refunds: Full refunds will only be allowed up to and as of the first Saturday practice (August 6). After
August 6, 2016 no refunds will be given.
****More information is available online at www.kmsd.edu/communityed or www.kmjlf.org ****
Important Dates:
March 2, 2016 @ 7pm – Informational Meeting (optional/those new to the program) –High School
Library
March 8, 2016 - Registration Deadline –firm deadline as team commitments are required for the league
June 6, 2016 @ 6:30 pm -Parent information meeting HS Auditorium
July 16, 2016 - Equipment Handout Grades 7 & 8. Storage locker, S15w33816 Wolf Road Oconomowoc
July 23, 2016 - Equipment Handout Grades 5 & 6, Storage locker, S15w33816 Wolf Road Oconomowoc
August 1, 2016– Practice begins 5:30-7:30 pm. Physical cards must be turned in by this date. Most teams
practice 6 days per week Mon – Sat until School starts. School Practice schedule – 3 days per week (6
hours max) – Individual grades practice days are to be determined
August 20, 2016 - League Scrimmage
August 27, 2016 – First League Game
September 14, 2016 - Team and Individual Picture Day
October 15, 2016 – Last League Game
- Learning Without Boundaries -
October 24 - 27, 2016 – Under the Lights Games. Specific days TBD
- Learning Without Boundaries -
Page 2
Registration will take place by mail. The cost is $250 per player. You will also be responsible to purchase
the practice player pack, for approximately $50 at our June informational meeting. Half of the
registration Fee ($125.00) is due with the Registration Forms no later than March 8, and the second half
($125.00) is due July 1. A $25 discount per player is offered to families with multiple players in the
program. If not paid by July 1, players will not receive equipment. Please make checks payable to KM
Community Education. If you have any questions, please contact the office at 262-968-6273 ext. 4252.
Families are required to volunteer during the season. This program cannot run without your support.
Refunds: Full refunds will only be allowed up to and as of the first Saturday practice (August 6). After
August 6, 2016 no refunds will be given.
****More information is available online at www.kmsd.edu/communityed or www.kmjlf.org ****
Important Dates:
March 2, 2016 @ 7pm – Informational Meeting (optional/those new to the program) –High School
Library
March 8, 2016 - Registration Deadline –firm deadline as team commitments are required for the league
June 6, 2016 @ 6:30 pm -Parent information meeting HS Auditorium
July 16, 2016 - Equipment Handout Grades 7 & 8. Storage locker, S15w33816 Wolf Road Oconomowoc
July 23, 2016 - Equipment Handout Grades 5 & 6, Storage locker, S15w33816 Wolf Road Oconomowoc
August 1, 2016– Practice begins 5:30-7:30 pm. Physical cards must be turned in by this date. Most teams
practice 6 days per week Mon – Sat until School starts. School Practice schedule – 3 days per week (6
hours max) – Individual grades practice days are to be determined
August 20, 2016 - League Scrimmage
August 27, 2016 – First League Game
September 14, 2016 - Team and Individual Picture Day
October 15, 2016 – Last League Game
October 24 - 27, 2016 – Under the Lights Games. Specific days TBD
- Learning Without Boundaries -
KM CommunityEducation
349 N. Oakcrest Drive
Wales, WI 53183
262-968-6273 ext. 4252
Total cost of participation is $250. $125 due with registration, $125 due July 1. A $25 discount per player is offered to families with
multiple players in the program. Registration deadline is March 8. A $50.00 late fee will be charged for registrations received after
March 8 and placed on a wait list. Please make checks payable to KM Community Education. Credit Card payment is accepted at
Community Education at the above address or phone number.
Player Name _______________________________ Home Phone __________________ 2016/2017 Grade______
Address _____________________________________City ____________________________ Zip ______________
KMMS _______________ other School __________________________________Shirt Size (adult or Youth)_____________
Birth Date ____________________ Height ______________________ Weight _____________________________
Primary Contact Name _______________________________________Email________________________________
Address (if different) ___________________________________________________________Phone_________________
Secondary contact name ________________________________E-Mail (if different) _____________________________
Address (if different) ___________________________________________________________Phone_________________
In Case of Emergency Contact (if different) __________________________________________________________
Medical Insurance Company ______________________________________________________________________
Parental Release from Liability and Request for Emergency Medical Administration:
I hereby agree to indemnify and hold harmless the School District of Kettle Moraine, its board members, employees, officials, officers, agents, or agents'
employees from all loss, damages, liability or claims arising out of participation in the Jr. Laser Football operations. I also agree to respond to and
cooperate with any defense of investigation and claim or alleged claim made against the School District of Kettle Moraine, its board members,
employees, officials, officers, agents or agents' employees, arising out of my participation. The School District of Kettle Moraine shall have the right to
approve any legal counsel selected to defend the School District of Kettle Moraine in such a claim or alleged claim. The School District of Kettle Moraine
does not discriminate on the basis of religion, sex, race, color, national origin, age, ancestry, creed, political affiliation, membership in the National
Guard, state defense force or any reserve component of the United States Military or state military forces, pregnancy, marital or parental status, sexual
orientation or physical, mental, emotional, or learning disability or handicap or other basis prohibited under state or federal law. IMPORTANT: It is the
parent/guardian responsibility to advise the Community Education staff of any medical condition that could become a medical situation.
I have read and understand the bylaws of the KM Jr. Laser football program including the Code of Conduct, and understand and agree to
abide by my duties and obligations as a coach, player, or parent representing the Kettle Moraine Jr. Laser Football Program, including
volunteering once during the season.
Date ________ Parent/Guardian Signature ________________________________Cell number_____________________
Kettle Moraine Jr. Laser Football Club Website
PLAYER AND PARENT/GUARDIAN AUTHOURIZATION TO
PUBLISH INFORMATION ON THE KETTLE MORAINE JR. LASER
FOOTBALL WEBSITE AND ON THE WORLD WIDE WEB.
By signing below, I authorize the Kettle Moraine Jr. Laser Football to
publish the following information concerning
______________________________ (name of player) on the KM Jr. Laser
Football website. This would include players first and last name, team, individual,
and candid photos pertaining to football, banquet, team events, team rosters, practices and
games; and any other team related information
Website: www.kmjlf.org
I understand that such publication will give unknown persons unlimited
access to this information, and that the KM Jr. Laser Football Club will not
control who has access to the information being used. The KM Jr. Laser
Football Club shall be authorized to publish this information on its website
until I provide Community Education with written notice revoking this
authorization.
Both parent’s/guardian’s signatures are required if applicable.
______________________________
(Parent’s/Guardian’s Signature)
________________
Date
______________________________
(Player’s Name Printed)
________________
Date
CONCUSSION IN SPORTS
A FACT SHEET FOR KETTLE MORAINE
ATHLETES AND PARENTS*
WHAT IS A CONCUSSION?
A CONCUSSION IS A BRAIN INJURY THAT:
• Is caused by a bump, blow or jolt to the head or body.
• Is always serious and can change the way your brain works.
• Can occur during practices or games in any sport or
recreational activity or motor vehicle accident.
• Can happen even if you have not lost consciousness.
• Can be serious even if you have just been dinged or
“had a ringer.”
WHAT ARE THE SIGNS AND SYMPTOMS?
SIGNS OBSERVED BY PARENTS OF OTHERS
•
•
•
•
•
•
•
•
Appears dazed or stunned
Is confused
Forgets instructions
Is unsure of game, score, or opponents
Moves clumsily
Shows mood, behavior, or personality change
Cannot recall events prior to hit or fall
Cannot recall events after hit or fall
SYMPTOMS REPORTED BY THE ATHLETE
•
•
•
•
•
•
•
•
Head ache or pressure
Nausea or vomiting
Balance problem or dizziness
Double or blurry vision
Sensitivity to light or noise
feeling sluggish, hazy, foggy or groggy
Concentration or memory problems
Just not feeling “right” or “feeling down”
WHAT TO DO IF YOU SUSPECT A
CONCUSSION:
TELL THE COACH, ATHLETIC TRAINER OR SCHOOL
NURSE. They need to know if you have had a head injury
or if you have had a previous concussion.
SEEK MEDICAL ATTENTION. A health care professional
experienced in evaluating concussions will be able to diagnose and treat a concussion and determine when it is safe to
return to plan. A student who sustains a concussion cannot
return to a Kettle Moraine athletic activity until a qualified
health care professional indicates it is safe to do so. (physician, nurse, athletic trainer)
STAY OUT OF PLAY UNTIL FULLY RECOVERED.
A concussed brain needs time to heal. While a brain is still
healing there is a much greater chance of another concussion. Repeat concussions can slow recovery and increase
the likelihood of long-term problems. In rare cases, repeat
concussions can result in permanent brain damage and
even death.
INFORM THE SCHOOL STAFF OF ALL CONCUSSIONS.
A concussion can impact a student’s ability to do academic
work and other activities such as computer use, studying,
driving or exercising. If needed the school nurse and
your teachers can help adjust school activities during the
recovery period.
REST IS THE ONLY TREATMENT FOR CONCUSSION.
Physical and cognitive rest are necessary for the brain to
return to normal functioning. Any activities that provoke
the reoccurrence of symptoms should be discontinued.
If you think you have a concussion: Don’t hide it! Report it! Take time to recover!
*This information comes from the Centers for Disease Control and Prevention, “Heads Up, Concussion in High School Sports”, www.cdc.gov
CONCUSSION IN SPORTS
A FACT SHEET FOR KETTLE MORAINE
ATHLETES AND PARENTS*
CONCUSSION DANGER SIGNS
Be alert for symptoms that worsen over time. Your
child or teen should be seen in an emergency department right away if he/she exhibits any of the following
symptoms:
• One pupil (the black part in the middle of the eye)
larger than the other
• Drowsiness or cannot be awakened
• A headache that gets worse and does not go away
• Weakness, numbness, or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Difficulty recognizing people or places
• Increasing confusion, restlessness, or agitation
• Any loss of consciousness should be taken
very seriously
RETURN TO PLAY GUIDELINES
Children and teens with a concussion should never return to
sports or recreation activities on the same day the injury occurred. They should delay returning to their activities until a
health care professional experienced in evaluating for concussion says they are symptom-free and it’s OK to return to play.
This means, until permitted, not returning to:
• Physical Education (PE) class,
• Sports practices or games, or
• Physical activity at recess
Current recommendations are for a stepwise return to play
program. In order to resume activity, the athlete must be symptom free and off any pain control or headache medications.
The athlete should be carrying a full academic load without
any significant accommodations. Finally, the athlete must have
clearance from an appropriate health care provider.
The program described below is a guideline for returning concussed athletes when they are symptom free. Athletes with multiple concussions and athletes with prolonged symptoms often
require a very different return to activity program and should be
managed by a physician that has experience in treating concussion. The following program allows for one step per 24 hours.
The program allows for a gradual increase in heart rate/physical
exertion, coordination, and then allows contact. If symptoms return, the athlete should stop activity and notify their healthcare
provider before progressing to the next level.
STEP ONE: About 15 minutes of light exercise:
stationary biking or jogging
STEP TWO: More strenuous running and sprinting
in the gym or field without equipment
STEP THREE: Begin non-contact drills in full uniform.
May also resume weight lifting
STEP FOUR: Full practice with contact
STEP FIVE: Full game clearance
If you think you have a concussion: Don’t hide it! Report it! Take time to recover!
CONCUSSION IN SPORTS
CONCUSSION POLICY CONSENT
Re: Wisconsin Act 172 – Concussion Policy
Relating to concussion and other head injuries sustained in youth athletic activities
CONCUSSION INFORMATION –
KNOW THE RULES AND WHEN IN DOUBT, SIT THEM OUT!
Before a student may participate in practice, competition or youth athletic activities sponsored by the School District of Kettle Moraine the person operating the youth athletic activity shall distribute a concussion and head injury information sheet to each coach
or instructor and to all participants and their parent/guardian. Participation will not be permitted in the absence of student and
parent/guardian acknowledgement and a signed Concussion Policy Consent Form.
An athletic coach, or official involved in a youth athletic activity, or health care provider shall remove a person from the youth athletic activity if the coach, official, or health care provider determines that the person exhibits signs, symptoms, or behavior consistent with a concussion or head injury or the coach, official, or health care provider suspects the person has sustained a concussion
or head injury.
A person who has been removed from a youth athletic activity may not participate in a youth athletic activity until he or she is
evaluated by a health care provider and receives a written clearance to participate in the activity from the health care provider.
SCHOOL DISTRICT OF KETTLE MORAINE: CONCUSSION POLICY CONSENT FORM
Statement acknowledging receipt of education and responsibility to report signs or symptoms of concussion to be included as part
of the “Participant and Parental Disclosure and Consent Document.”
I,
(Student/Athlete Name) hereby acknowledge having
received education about the signs, symptoms, and risks of sport related concussion. I also acknowledge my responsibility to report
to my coaches, parent(s)/guardian(s) any signs or symptoms of a concussion.
Print Student/Athlete Name
Student/Athlete Signature
Grade
Date
Sport/Activity
I, the parent/guardian of the student athlete named above, hereby acknowledge having received education about the signs, symptoms, and risks of sport related concussion.
Print Parent/Guardian
Parent/Guardian Signature
PLEASE RETURN CONSENT FORM TO THE KMHS ATHLETIC DEPARTMENT:
Kettle Moraine High School
349 N. Oak Crest Drive 53183
Wales, WI
Forms due by:
Date
WISCONSIN INTERSCHOLASTIC ATHLETIC ASSOCIATION PHYSICAL EXAMINATION CARD
APPROVAL FOR TWO YEARS OF COMPETITION-EXAMINATION CANNOT BE TAKEN BEFORE APRIL 1
ATHLETES CANNOT PARTICIPATE IN PHYSICAL ACTIVITY IN ANY WAY UNTIL THIS CARD IS TURNED IN TO THE COMMUNITY
EDUCATION OFFICE
Name____________________________________________________________________ Date of Birth___________ Grade________ Age________ Gender__________
Last
Middle Initial
First
The above named student has been examined and there are no apparent contraindications to participating in interscholastic athletic activities except as follows:
Sports or school activities in which this student cannot participate are as follows: (if none-write NONE)
__________________________________________________________________________________________________________________________________
If student is restricted or disqualified, please indicate reasons: _________________________________________________________________________________
If approved for only one year of competition, please check here:________ Doctor’s Signature______________________________________________________
Doctor’s Address______________________________________________________ Date of Examination____________________________________________
City & State__________________________________________________________ Telephone_____________________________________________________
Athletes Address of Primary Residency______________________________________________ Home Telephone______________________________________
City/Town/Village_________________________________________ Zip Code______________ Parent Cell Phone_____________________________________
PARENT PERMISSION AND ACKNOWLEDGEMENTS:
1.
2.
3.
4.
I, as a parent or legal guardian of the above athlete, have read, understand, and therefore agree to support the policies and rules set forth for athletes and give my son
permission to participate under those conditions.
I also give permission for school personnel, in an emergency situation at a school athletic event; to make decisions on certified medical assistance, first aid and care to
my child should he/she require such assistance or emergency first aid by the coach.
As the parent (or legal guardian) of the above named athlete, I agree to be financially responsible for the safe return of all athletic equipment issued to him/her. I further
agree to hold my son/daughter financially accountable for any and all equipment, which he/she might lose, misplace, or damage.
I realize that there is an inherent risk of injury through participating in all sports. I realize this risk may be severe, including the risk of fractures, brain injuries,
paralysis or even death. I have sufficient insurance and am willing to take full financial responsibility for any and all injuries sustained by my child while participating
in the interscholastic athletic program under the direction of Kettle Moraine High School.
Signature of Parent/Legal Guardian__________________________________________________________________ Date_________________________
ATHLETES CANNOT PARTICIPATE IN PHYSICAL ACTIVITY IN ANY WAY UNTIL THIS CARD IS TURNED IN TO THE
COMMUNITY EDUCATION OFFICE
ATHLETIC CODE OF CONDUCT: Kettle Moraine students have established five core values that are basic to good citizenship and good sportsmanship. These student identified
core values are: 1) Mutual Respect, 2) Honesty, 3) Good Communication, 4) Open-mindedness to Diversity, and 5) Maintaining a strong work ethic. Since athletes represent the school,
their behavior and appearance frequently determine the opinion others have of the school and the individuals within the school. Training rules and abiding by the athletic code of
conduct are a matter of self discipline. The best performance an individual is capable of producing comes only after the body and the mind have been conditioned through a regular
training routine.
CONDUCT UNBECOMING AN ATHLETE: All student athletes shall observe the following training rules both in-season and out-of-season for the athlete’s entire school career,
including vacation periods. Possession or use of a controlled substance, tobacco, alcoholic beverages, illegal drugs, performance enhancing substances, fighting, theft, possession of
stolen property, negative acts against persons or property, conduct resulting in suspension from school are examples of conduct unbecoming an athlete. Conduct unbecoming an athlete
could result in suspension from competition as per standards outlined in the formal code of conduct. (The complete code of conduct can be found in the parent/athlete handbook/athletic
website.)
Any coach, teacher, administrator, law enforcement officer, or adult member of the community who becomes aware of a possible violation of the code of conduct will report the
violation to the Athletic Director in a signed written communication. Upon receiving a validated report, the Athletic Director shall investigate the charge. It is our expectation that any
athlete who violates the code of conduct will knowingly and willingly refer their violation to the Athletic Director.
WE, AS PARENT AND ATHLETE, HAVE READ, UNDERSTAND, AND THEREFORE AGREE TO ABIDE BY ALL RULES AND REGULATIONS SET FORTH IN THE
KETTLE MORAINE HIGH SCHOOL CODE OF CONDUCT FOR PARTICIPATION IN INTERSHCOLASTIC ATHLETICS.
Parent/Guardian Signature________________________________________________________________________ Date____________________________
Athlete Signature_______________________________________________________________________________ Date____________________________
Parent/Legal Guardian Signature___________________________________________________________________ Date___________________________
WISCONSIN INTERSCHOLASTIC ATHLETIC ASSOCIATION BROWN PERMIT ALTERNATE YEAR CARD
Form to be used only if physical is dated after 4-1-15
ATHLETES CANNOT PARTICIPATE IN PHYSICAL ACTIVITY IN ANY WAY UNTIL THIS CARD IS TURNED IN TO THE
ATHLETIC OFFICE
Name__________________________________________________________ Date of Birth___________ Grade_______ Age______ Gender_________
Last
Middle Initial
First
PARENT PERMISSION AND ACKNOWLEDGEMENTS:
1.
2.
3.
4.
5.
I, as a parent or legal guardian of the above athlete, have read, understand, and therefore agree to support the policies and rules set forth for athletes at
Kettle Moraine School District and give my son/daughter permission to participate under those conditions.
I also give permission for school personnel, in an emergency situation at a school athletic event, to make decisions on certified medical assistance,
first aid and care to my child should he/she require such assistance or emergency first aid by the coach.
As the parent (or legal guardian) of the above named athlete, I agree to be financially responsible for the safe return of all athletic equipment issued
to him/her. I further agree to hold my son/daughter financially accountable for any and all equipment, which he/she might lose, misplace, or damage.
I realize that there is an inherent risk of injury through participating in all sports. I realize this risk may be severe, including the risk of fractures,
brain injuries, paralysis or even death. I have sufficient insurance and am willing to take full financial responsibility for any and all injuries sustained
by my child while participating in the interscholastic athletic program under the direction of Kettle Moraine High School.
I also attest to the fact that the above named student has not had a significant operation, serious illness, or injury requiring prolonged treatment since
the pre-participation examination.
Parent: If there is any question that this student may not be qualified for athletic completion without, at least, a partial re-examination, contact your
medical advisor before signing the card.
Signature of Parent/Legal Guardian__________________________________________________________________ Date_________________________
ATHLETES CANNOT PARTICIPATE IN PHYSICAL ACTIVITY IN ANY WAY UNTIL THIS CARD IS TURNED IN TO THE
ATHLETIC OFFICE
ATHLETIC CODE OF CONDUCT: Every member high school of the Wisconsin Interscholastic Athletic Association (WIAA) is required to have a code of conduct for all student
participants. Kettle Moraine students have established five core values that are basic to good citizenship and good sportsmanship. These student identified core values are: 1) Mutual
Respect, 2) Honesty, 3) Good Communication, 4) Open-mindedness to Diversity, and 5) Maintaining a strong work ethic. Since athletes represent the school, their behavior and
appearance frequently determine the opinion others have of the school and the individuals within the school. Training rules and abiding by the athletic code of conduct are a matter of
self discipline. The best performance an individual is capable of producing comes only after the body and the mind have been conditioned through a regular training routine.
CONDUCT UNBECOMING AN ATHLETE: All student athletes shall observe the following training rules both in-season and out-of-season for the athlete’s entire school career,
including vacation periods. Possession or use of a controlled substance, tobacco, alcoholic beverages, illegal drugs, performance enhancing substances, fighting, theft, possession of
stolen property, negative acts against persons or property, conduct resulting in suspension from school are examples of conduct unbecoming an athlete. Conduct unbecoming an athlete
could result in suspension from competition as per standards outlined in the formal code of conduct. (The complete code of conduct can be found in the parent/athlete handbook/athletic
website)
Any coach, teacher, administrator, law enforcement officer, or adult member of the community who becomes aware of a possible violation of the code of conduct will report the
violation to the Athletic Director in a signed written communication. Upon receiving a validated report, the Athletic Director shall investigate the charge. It is our expectation that any
athlete who violates the code of conduct will knowingly and willingly refer their violation to the Athletic Director.
WE, AS PARENT AND ATHLETE, HAVE READ, UNDERSTAND, AND THEREFORE AGREE TO ABIDE BY ALL RULES AND REGULATIONS SET FORTH IN THE
KETTLE MORAINE HIGH SCHOOL CODE OF CONDUCT FOR PARTICIPATION IN INTERSHCOLASTIC ATHLETICS.
Parent/Guardian Signature________________________________________________________________________ Date____________________________
Athlete Signature_______________________________________________________________________________ Date____________________________
WIAA RULES OF ELIGIBILITY: The WIAA requires all schools to distribute the WIAA Rules and Regulations pertaining to student eligibility in interscholastic athletics to each
parent/legal guardian. Please sign below that you have received your copy of the WIAA Rules and Regulations of Eligibility.
Parent/Legal Guardian Signature___________________________________________________________________ Date___________________________