This information sheet is provided to assist you and your child in recognizing the signs and symptoms of a concussion. Every athlete is different and responds to a brain injury differently, so seek medical attention if you suspect your child has a concussion. Once a concussion occurs, it is very important your athlete return to normal activities slowly, so he/she does not do more damage to his/her brain.

What is a concussion

NOTICE:

Below you will find the new social networking guidelines which provide the following guidelines for Clark coaches & Student-Athletes for social networking site usage:

• Everything you post is public information – any text or photo placed online is completely out of your control the moment it is placed online – even if you limit access to your site. Information (including pictures, videos, and comments) may be accessible even after you remove it. Once you post a photo or comment on a social networking site, that photo or comment becomes the property of the site and may be searchable even after it’s removed.

• What you post may affect your future. Many employers and college admissions officers review social networking sites as part of their overall evaluation of an applicant. Carefully consider how you want people to perceive you before you give them a chance to misinterpret your information (including pictures, videos, comments, and posters).

• Similar to comments made in person, the Clark Montessori Athletic Department will not tolerate disrespectful comments and behavior online, such as:

- Derogatory language or remarks that may harm my teammates or coaches; other Clark student athletes, teachers, or coaches; and student-athletes, coaches, or representatives of other schools, including comments that may disrespect my opponents.

- Incriminating photos or statements depicting violence; hazing; sexual harassment; full or partial nudity; inappropriate gestures; vandalism, stalking; underage drinking, selling, possessing, or using controlled substances; or any other inappropriate behaviors.

- Creating a serious danger to the safety of another person or making a credible threat of serious physical or emotional injury to another person.

- Indicating knowledge of an unreported school or team violation—regardless if the violation was unintentional or intentional.

In short, do not have a false sense of security about your rights to freedom of speech. Understand that freedom of speech is not unlimited. The on-line social network sites are NOT a place where you can say and do whatever you want without repercussions. The information you post on a social networking site is considered public information. Protect yourself by maintaining a self-
image of which you can be proud for years to come.

By signing this document, I have read it to its entirety and fully understand Clark Athletics Social Media Policy. I understand the potential consequences the may result from misusing social media avenues the detrimental affects it can have on a individual, team, athletic department, school, and community.

I hereby give consent for the following medical care providers and local hospital to be called.

Please enter the name of the extra curricular activities you'd like to participate in.

If I cannot be contacted and a reasonable effort has been made to do so, I authorize the coaching staff or the Principal and his or her designee to act on my behalf. I further authorize my son/daughter to be transferred and admitted to any hospital or medical facility for diagnosis and treatment if deemed necessary. I request and authorize any duly licensed Doctors of Medicine, Doctors of Dentistry or other such licensed technicians or nurses to perform any diagnostic, treatment or operative procedures including x-ray diagnosis of my child. I assume the responsibility for the payment of any such transfer and treatment.

If parents cannot be contacted, please call:

If yes, provide the name of your insurance company and policy number in the "Medical/Emergency Information" section on this form.

I certify that I am the parent/legal guardian of the above-named student; that I have read and understand this Release of Liability and Assumption of Risk Agreement. I certify that I have explained the risks and dangers to my child. I hereby release and hold harmless the Cincinnati Public Schools, its Partners in Education, coaches, volunteers, medical personnel, security officers, administrative officials, other employees, volunteers and agents from any liability, actions, causes of action, claims, judgements cost or expense, including attorney fees, known or unknown at this time, arising out of or in any way related to any injury or illness incurred by my child while participating in, or travelling to and from any practice, game, or special event. I have voluntarily chosen to allow my child to participate and assume all such dangers and risks. I request that my son/daughter be permitted to participate in extracurricular athletic activities sponsored by the Cincinnati Public Schools.

Permission is granted for the above mentioned student to be transported by coaches, other parent(s)/guardian(s) and/or fellow students who are licensed drivers as indicated below while participating in activities at Clark Montessori High School.

In the event that no school district transportation is provided, I authorize and allow my child to use the following mode(s) of transportation while participating in the school sponsored activity.

In the event that no school district transportation is provided, I authorize and allow my child to use the following mode(s) of transportation.

(Drivers under the age of 17 will not be permitted to have more than one person who is not a family member in the vehicle unless accompanied by the license holder's parent or guardian.)

By signing this document, I hereby expressly waive and release any and all rights and claims of any nature whatsoever I/we may have against the Cincinnati Public School District, the Board of Education, and its members and employees, arising out of, in connection with or resulting from participation in the school activity they involved in.