ATHLETIC CLEARANCE PACKET CLEARANCE PACKET IS DUE AUGUST 24th FOR ALL ATHLETES

Ambassador High School 540 Maple Ave Torrance Ca 90503 Luke Duperron Athletic Director - lduperron@ambassadorhigh.org - 310-356-0956

ATHLETIC CLEARANCE PROCEDURE *CLEARANCE PACKET IS DUE AUGUST 24th.

Athletes may not participate in practice or games after August 24th if clearance packet is not turned in.

Please follow the steps below to complete your Athletic Clearance Packet:

1. Please thoroughly read the Athletic Clearance Packet in its entirety. The packet is due August 24th with completed forms:

a. Interest Form b. Medical Release c. Booster Club

2. A doctor must complete the Medical Release Form, sign and affix his/her stamp BEFORE a student can be cleared. All other forms can be completed by the student athlete and parent/guardian at home.

3. Bring your COMPLETED Clearance Packet, form to the Athletic Director, Luke Duperron, to the school office during the following scheduled times:

Athletic Director Office Hours: M – F 7:30 am – 4:30 pm

CLEARANCE PACKET IS DUE AUGUST 24th FOR ALL ATHLETES

AHS ATHLETICS INTEREST FORM CLEARANCE PACKET IS DUE AUGUST 24th FOR ALL ATHLETES

ATHLETE’S NAME:__________________________________________________

❑ MALE ❑ FEMALE GRADE 12 ❑ 11 ❑ 10 ❑ 9 ❑

T-Shirt Size S ❑ M ❑ L ❑ XL ❑ XXL ❑

PARENT’S EMAIL:________________________ PARENT’S EMAIL:____________________________

FALL

CLEARANCE PACKET IS DUE AUGUST 24th FOR ALL ATHLETES TEAM SPORT FALL WINTER SPRING ❑Volleyball (Girls) ❑ Basketball (Boys) ❑ Volleyball (Boys)

❑ Soccer (Girls)

SPONSORED SPORT* FALL WINTER SPRING ❑ Cross Country (Boys, Girls) ❑ Swim (Boys, Girls) ❑ Golf (Girls) ❑ Track (Boys, Girls) ❑ Golf (Boys, Girls)

SPONSORED SPORT A sponsored sport at AHS is an opportunity for individuals to represent our athletics program by practicing and playing events on their own. While AHS does not provide a coach for the sponsored sport, it will work together with the athlete to construct a schedule. AHS families can purchase uniforms and AHS athletic gear from our team store at www.eastbayteamsales.com. The fee covers league, invitational, and tournament fees.

AMBASSADOR ATHLETIC FEES

SPONSORED SPORT A sponsored sport at AHS is an opportunity for individuals to represent our athletics program by practicing and playing events on their own. While AHS does not provide a coach for the sponsored sport, it will work together with the athlete to construct a schedule. AHS families can purchase uniforms and AHS athletic gear from our team store at www.eastbayteamsales.com. The fee covers league, invitational, and tournament fees.

FUNDRAISING EVENTS AHS fundraising events are the Fall Pancake Breakfast and Snap Raise. All proceeds help offset our coaching staff costs, equipment, and awards for the end of the year athletics banquet. All athletes must attend AHS athletic fundraising. AHS athletic fundraising does not count towards the athletic fee.

ATHLETICS BANQUET The athletics banquet is held at the Redondo Beach Cheesecake Factory in May. Tickets are $35. Please plan for Valet parking ($4.00). Tickets may be purchased in the front office by April 1st.

TEAM / FAN ATHLETIC WEAR Team and fan gear for all sports may be purchased from our Eastbay Team Store online. Athletic jerseys are provided by the school and must be returned at the end of the season. Each athlete will receive two sport specific t-shirts to wear during practice provided by the athletics program. Cardinal or black shorts must be worn at all AHS practices. All Ambassador athletic gear for players or family members can be purchased at www.eastbayteamsales.com.

Fall Team Sport Winter Team Sport Spring Team Sport

Girls Volleyball: $550 Basketball: $550 Boys Volleyball: $550Girls Soccer: $550

Fall Sponsored Sport Winter Sponsored Sports Spring Sponsored SportCross Country: $250 Swimming: $250Girls Golf: $250 Golf: $250

Fee Due August 31st Fee Due October 5th Fee Due February 15th

SPONSORED SPORT SPONSORED SPORT

CLEARANCE PACKET IS DUE AUGUST 24th FOR ALL ATHLETES

AMBASSADOR ATHLETICS BOOSTER CLUB The Ambassador Athletics Booster Club is vital to continuing the proud tradition of Ambassador athletics and to maintaining our overall facilities. Only one membership is required per family and all memberships are tax-deductible charitable contributions.

Parent/Guardian Names:__________________________________________________

Home Phone: _________________________ Cell Phone: _______________________

Email: ________________________________________________________________

Address: ______________________________________________________________

Student Name: ______________________________________ Current Grade: ______

Sports participating in: ___________________________________________________

Student Name: ______________________________________ Current Grade: ______

Sport (s):______________________________________________________________

Type of Membership (check one):

CARDINAL MEMBERSHIP ($100) T- Shirt Size: ______Receives Ambassador High School T-Shirt

GOLD MEMBERSHIP ($250)T- Shirt Sizes: ______ and ______ Nike Jacket Size:_______ Receives (2) Ambassador High School T-shirts, (1) Nike Jacket

Method of Payment: Check _____ Cash _____ Amount ________

Please submit this form along with payment. Make checks payable to Ambassador High School. Orders will be available September 19th.

AMBASSADOR FINANCIAL BREAKDOWN 2018-2019

(Girls Volleyball, Boys Basketball, Girls Soccer, Boys Volleyball) $12,650 Coaching Stipends (Head coach and assistants) $3,812 Referee Payments $1,300 Facility Rental $7,450 Jerseys $2,000 Athletic Trainer (Part time -C.I.F Mandated for 2018-2019 School year) $450 League Fees and State C.I.F Fees $27,662 Total

Fundraising Percentages toward Athletic Fee Business Partnership - 50 %

Media Guide - 50 % Letter Clubs - 100 %

AMBASSADOR MEDIA GUIDE/PROGRAM 2018-2019

The Ambassador High Athletics Program is creating a professionally produced media guide that will include team and school information, rosters, photos, schedules, AND YOUR SUPPORTIVE SPONSORSHIP. This outstanding program will be distributed to local and regional businesses and colleges, and will also be on the school website. The funds derived from the sponsorships go directly towards purchasing everything to run a first-class program including: uniforms, equipment, awards, travel, tournament fees, and banquet expenses. This is a tax deductible donation.

❑ BACK COVER SPONSORSHIP: $1,000 You will receive a color sponsorship promoting your business, plus your business will be featured with a 4 ft x 4ft banner during all of the teams’ home games.

❑ FRONT PAGE INSIDE OR BACK PAGE INSIDE SPONSORSHIP: $750 You will receive a sponsorship in either of the two highly visible sections promoting your business, plus your business will be featured with a 4 ft x 4ft banner during all of the teams’ home games.

❑ FULL PAGE SPONSORSHIP (The most popular choice): $500 You will receive a sponsorship promoting your business, plus your business will be featured with a 4 ft x 4ft banner during all of the teams’ home games.

❑ HALF PAGE SPONSORSHIP: $250 ❑ QUARTER PAGE SPONSORSHIP: $125 ❑ BUSINESS CARD SPONSORSHIP: $60

Please check which size sponsorship you chose above. The sponsorship dimensions are attached. Please E-mail sponsorship to lduperron@ambassadorhigh.org or save it as a pdf, jpeg, or ai file, and include it with this paperwork, along with a hardcopy so we can preview it. The artwork on the sponsorship must be camera-ready for printing. We cannot build sponsorships for you.

Disk included: _____ Artwork has been e-mailed: _____

Ambassador Player who solicited this sponsorship: ________________________ Company/sponsor name: ____________________________________________ Contact person from company/sponsor: ________________________________ Contact person’s phone number: ______________________________________ E-mail: ___________________________________________________________ Make checks payable to Ambassador High School and mail to:

Ambassador High School Attn: Luke Duperron, Athletic Director

540 Maple Ave Torrance Ca 90503

Partnership Ad Sizes:Full page 6.334” w x 7.834” h

1/2 half page 6.334” w x 3.8337” h

1/4 page 3.0837” w x 3.8337” h

business card 3.0837” w x 1.8335” h

1

CONCUSSION RETURN TO PLAY PROTOCOL CA STATE LAW AB 2127 (Effective 1/1/15) STATES THAT RETURN TO PLAY (I.E., COMPETITION) CANNOT BE SOONER THAN 7 DAYS AFTER EVALUATION BY A PHYSICIAN (MD/DO) WHO HAS MADE THE DIAGNOLSIS OF CONCUSSION. Instructions: This graduated return to play protocol MUST be completed before a student athlete can return to FULL COMPETITION.

x A certified athletic trainer (AT), physician, and/or identified concussion monitor (e.g., coach, athletic director) must monitor your progression and initial each stage after you have successfully pass it.

x Stages I to II-D take a minimum of 6 days to complete x You must be back to normal academic activities before beginning Stage II, unless otherwise instructed by your

physician. x You must complete one full practice without restrictions (Stage III) before competing in first game.

After Stage I you cannot progress more than one stage per day (or longer if instructed by your physician). If symptoms return at any stage in the progression, IMMEDIATELY STOP any physical activity and follow up with your school’s AT, other identified concussion monitor, or your physician. In general, if you are symptom-free the next day, return to the previous stage where symptoms had not occurred. Seek further medical attention if you cannot pass a stage after 3 attempts due to concussion symptoms, or if you feel uncomfortable at any time during the progression.

You must have written physician (MD/DO) clearance to begin and progress through the following Stages as outlined below (or as otherwise directed by physician)

Date & Initials

Stage

Activity

Exercise Example

Objective of the Stage

I

No physical activity for at least 2 full symptom-free days AFTER you have seen a physician

x No activities requiring exertion (Weight lifting, jogging, P.E. classes)

x Recovery and elimination of symptoms

II-A

Light aerobic activity

x 10-15 minutes (min) of walking or stationary biking.

x Must be performed under direct supervision by designated individual

x Increase heart rate to no more than 50% of perceived maximum (max) exertion (e.g., 100 beats per min)

x Monitor for symptom return

II-B

Moderate aerobic activity (Light resistance training)

x 20-30 min jogging or stationary biking

x Body weight exercises (squats, planks, push-ups), max 1 set of 10, no more than 10 min total

x Increase heart rate to 50-75% max exertion (e.g., 100-150 bpm)

x Monitor for symptom return

II-C

Strenuous aerobic activity (Moderate resistance training)

x 30-45 min running or stationary biking

x Weight lifting ≤ 50% of max weight

x Increase heart rate to > 75% max exertion

x Monitor for symptom return

II-D

Non-contact training with sport-specific drills (No restrictions for weightlifting)

x Non-contact drills, sport-specific activities (cutting, jumping, sprinting)

x No contact with people, padding or the floor/mat

x Add total body movement x Monitor for symptom return

Minimum of 6 days to pass Stages I and II. Prior to beginning Stage III, please make sure that written physician (MD/DO) clearance for return to play, after successful completion of Stages I and II, has been given to your school’s concussion monitor

III

Limited contact practice x Controlled contact drills allowed (no scrimmaging)

x Increase acceleration, deceleration and rotational forces

x Restore confidence, assess readiness for return to play

x Monitor for symptom return

Full contact practice Full unrestricted practice

x Return to normal training, with contact

x Return to normal unrestricted training

MANDATORY: You must complete at least ONE contact practice before return to competition, or if non-contact sport, ONE unrestricted practice (If contact sport, highly recommend that Stage III be divided into 2 contact practice days as outlined above) IV Return to play (competition) x Normal game play (competitive

event) x Return to full sports activity without

restrictions Athlete’s Name:________________________ Date of Concussion Diagnosis:___________________

BUSINESS SPONSORSHIP $10,000 • Premier logo on all print and marketing athletic material• Premier logo on the back of athletic t-shirts • Premier logo on main portable basketball goals • Full page ad in Athletics Banquet Media Guide • Website, Facebook, Instagram acknowledgment• Includes 2 jackets, 2 t-shirts, and 2 AHS decals• 4ft x 8ft Banner in gymnasium• 2 tickets to Athletics Banquet

$5,000 • Sponsor logo on main portable basketball goals • Sponsor logo on the back of athletic t-shirts• Full Page ad in Athletics Banquet Media Guide • Website, Facebook, Instagram acknowledgment• Includes 2 jackets, 2 t-shirts, and 2 AHS decals• 4ft x 8ft Banner in gymnasium• 2 tickets to Athletics Banquet

$2,500 • Sponsor logo on main portable basketball goals• Partnership logo on the back of athletic t-shirts • Half page ad in Athletics Banquet Media Guide • Website, Facebook, Instagram acknowledgment• Includes 2 jackets, 2 t-shirts, and 2 AHS decals• 4ft x 8ft Banner in gymnasium• 2 tickets to Athletics Banquet

$1,000 • Half page ad in Athletics Banquet Media Guide • Website, Facebook, Instagram acknowledgment• Includes 2 jackets, 2 t-shirts, and 2 AHS decals• 4ft x 8ft Banner in gymnasium• 2 tickets to Athletics Banquet

$600 • Includes 2 jackets, 2 t-shirts, and 2 AHS decals• 4ft x 4ft Banner in gymnasium• Website, Facebook, Instagram acknowledgment$200 • Includes 2 T-shirts• 4ft x 4ft Banner in gymnasium

LIONSA M B A S S A D O R