ATHLETIC/ EXTRA CURRICULAR

PARTICIPATION HANDBOOK

FOLSOM CORDOVA UNIFIED SCHOOL DISTRICT 1965 Birkmont Drive

Rancho Cordova, CA 95742 Phone (916) 294-9000 Fax (916) 294-9020

Revised September 2015 Business Services

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FOLSOM CORDOVA UNIFIED SCHOOL DISTRICT

EXTRA CURRICULAR PARTICIPATION HANDBOOK

Participation in school sports and extra curricular programs is a privilege, not a right. To earn that privilege, students must abide by the rules and they must conduct themselves as positive role models who exemplify good character. The school intends to maintain programs that are well managed and meet the needs of the students and the school community. Club information, athletic schedules, and coaching information can be found on our individual school websites. http://www.fcusd.org then click on Our Schools, the individual school, and then the appropriate link.

The athletic program will promote sportsmanship and all programs will foster the development of good character by enhancing the academic, emotional, social, physical and ethical development of students and teaching positive life skills that will help students become personally successful and socially responsible.

Students are considered representatives of FCUSD, as well as their individual schools, by their participation as a member of an athletic team or other program. As such, they are expected to maintain exemplary behavior and citizenship. All students will be held responsible for any involvement in acts specified in the Student Handbook (Campus Rules / Policies) whether on campus, at school activities or in the community.

1) Attendance

i) Game/Event Day: Non attendance for any part of the school day may result in no participation in an event or athletic contest, unless prior approval is received from the vice principal.

ii) Practice: Students not attending school may not participate in practice or event on that day without prior permission from the vice principal.

iii) With prior vice principal approval, parent may transport student to event if the student was absent for an approved reason (i.e. doctor appointment, etc.)

2) Expectations of Students

i) Any student who has been suspended for possessing, using, selling, furnishing, or being under the influence of any controlled substance, for possession or use of tobacco or any tobacco product, inappropriate conduct or unsportsmanlike behavior during an athletic contest or event, will be immediately suspended from the team or club participation for a two-week period. A formal hearing with the vice principal, coach/advisor, and athletic director will be held during this time. The results of that hearing will determine whether or not the student may continue to participate in the activity.

ii) Suspension - If a coach/advisor suspends a student, the student will be ineligible for participation. A hearing with the vice principal, coach/advisor, athletic director, parent and student will be held. The results of that hearing will determine whether or not the student may remain on the team or in the club.

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iii) Grade Checks – A periodic grade check may be held to help students maintain the required GPA. If grades are close to or below 2.0 GPA, student will be responsible to arrange and attend extra tutoring sessions with the teacher in order to improve.

iv) Citizenship – Students are expected to maintain excellent citizenship in conjunction with the “Six Pillars of Character” (see Code of Conduct Form.) as well as the CIF “Victory with Honor” standards. Individual behavior standards should be of the highest quality so as to not adversely reflect on their team or school. This includes “attitude” as well as behavior in classes, rallies, assemblies and any athletic or school events.

v) Proper Uniforms – Athletes must wear uniforms or equipment as specified by the coach / athletic director, (according to CIF rules.)

3) Road Trips

i) The district provides transportation to almost all “away” contests. Students are expected to go and return on the district provided transportation.

(a) FCUSD Transportation Department and Delta River League/ Sierra Valley Conference often determine bus departure times.

(b) At the coach/advisor’s discretion, students may be signed off the return bus by the parent/guardian. Parents must complete a “Volunteer/Personal Vehicle Use” form at the start of the season and at the event sign the Extra Curricular Transportation Release Sign-Out Sheet stating their intention to drive their child home and releasing the district from liability. If the student will be riding home with another adult, the Alternate Transportation Release form must be on file indicating the appropriate drivers and the Extra Curricular Transportation Release Sign-Out Sheet should be signed by the appropriate driver.

(c) All students will dress in an appropriate manner for bus trips. Coaches/advisors will establish proper attire.

(d) Personal items are the responsibility of the students. Personal electronic devices may be allowed at the coach/advisor’s discretion.

ii) If district transportation is NOT provided, an Alternate Transportation Form must be completed by parents and coach/advisor and on file with the athletic director or advisor prior to departure. Depending on who is providing transportation, other driving forms are required.

iii) Students are NEVER allowed to drive their own vehicles to or from an event unless it is with coach/advisor’s request and proper forms are on file with the athletic director or advisor: Alternate Transportation Form (signed by parent and coach/advisor to request student’s driving), Personal Auto Use form (parents complete), & Student Personal Auto Form (parents & student complete).

4) Extra-Curricular Discipline Consequences

i) Students, performers or competitors who violate rules as established by the coaches/advisors, will have the following consequences:

(a) First Violation – Coach/advisor will give a verbal warning explaining the violation

(b) Second Violation – One game suspension and contact parent/guardian about the matter

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(c) Third Violation – Two-week suspension, a formal hearing with the vice- principal, coach/advisor and athletic director will be held during this time. The results of that hearing will determine whether or not the student may continue to participate in the club or on the team.

5) Parent complaints or concerns

i) If you have a concern or complaint, it helps to bring it to the attention of the correct people. In general, a parent should communicate first with the school and then with the appropriate office in the district. Anonymous complaints will be read for informational purposes with no follow-ups.

(a) Every effort should be made to resolve a complaint with the coach/advisor involved.

(b) If the concern is not resolved with the coach/advisor, it should be submitted to the athletic director or vice-principal in writing.

(c) If the concern is not resolved athletic director or vice-principal, it should be submitted to the principal on a “Uniform Complaint Procedure Form.”

(d) If the principal cannot resolve the problem, it will be submitted to the Assistant Superintendent of Secondary Education on a “Uniform Complaint Procedure Form.”

6) Code of conduct for parents / guardians

i) The role of the parent in the education of a student is vital. The support shown in the home is often manifested in the ability of the student to accept the opportunities presented at school and in life.

ii) There is a value system – established in the home, nurtured in the school – which young people are developing. Their involvement in classroom and other activities contributes to that development. Trustworthiness, Citizenship, Caring, Fairness and Respect are lifetime values taught through extra curricular activities. These are the principles of good sportsmanship and character. With them, the spirit of competition thrives; fueled by honest rivalry, courteous relations and graceful acceptance of the results.

iii) As a parent of a student at our school, your goals should include: (a) Realize that extra curricular activities are part of the educational experience

and the benefits of involvement go beyond the final score of a game; (b) Encourage our students to perform their best, just as we would urge them on

with their class work; (c) Participate in positive cheers that encourage our student athletes and

discourage any cheers that would redirect that focus – including those that taunt and intimidate opponents, their fans and officials;

(d) Learn, understand and respect the rules of the game, the officials who administer them and their decisions;

(e) Respect the task our coaches/advisors face as teachers and support them as they strive to educate our youth and your children;

(f) Respect our opponents as students and acknowledge them for striving to do their best; treat them with courtesy and

(g) Develop a sense of dignity under all circumstances.

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iv) You can have a major influence on your student’s attitude about academics and athletics. The leadership role you take will help influence your child and our community for years to come.

7) Academic Eligibility For Extra Curricular Activities

i) The participant must be a full time student at their high school or middle school. Exception – Seniors on graduation track may have a reduced schedule.

ii) Academic – Students maintain an overall GPA of 2.0, based on the most recent trimester, quarter or semester.

iii) All 8th grade students who matriculate to grade 9 are eligible for participation in extra-curricular activities upon entry into high school.

iv) Independent Study students must be residents within the FCUSD boundaries and enrolled in an Independent Study Program supported through FCUSD. Students are responsible for contacting their school of residency. Students will be reviewed on a case by cases basis to determine eligibility.

The following pertains specifically to Athletics:

All athletes will abide by the CIF rules. (eligibility, residency, participation, etc.) Visit the website: www.cifsjs.org for more information.

8) Residential Eligibility

i) The CIF requires that students who participate on a school team must be living with parents or legal guardians who reside within the school’s attendance boundaries.

9) Academic Eligibility

i) The participant must be a full time student at their high school or middle school. Exception – Seniors on graduation track may have a reduced schedule.

ii) Academic – Students maintain an overall GPA of 2.0, based on the most recent trimester, quarter or semester.

iii) All 8th grade students who matriculate to grade 9 are eligible for participation in extra-curricular activities upon entry into high school.

iv) High School athletes planning to attend Division I colleges must be sure they have fulfilled the NCAA Clearinghouse Requirements. See your counselor for details.

10) Athletic Clearance

i) No student will be allowed to practice or participate until the following have been completed and turned in to your coach:

(a) EVERY form is complete and verified by the athletic director (see list) (b) Debts Cleared (School and Athletic) (c) Return of Athletic Equipment: When athletic equipment is checked out,

athletes are responsible for it. If not turned in at the end of the season, you will be held responsible. Athletes will not be cleared for a new sport until all debts are cleared with the student accounts office including the return of equipment from other sports.

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11) Equipment i) Students are responsible for the security of their equipment and uniforms. In some

cases, particularly with game uniforms, the replacement fee may be higher than the original purchase price because special processing and printing may be required to duplicate the uniform.

ii) Students are expected to turn in the same piece(s) of equipment checked out to them. They will be fined if they do not return the same pieces of equipment /uniforms that were issued to them.

iii) Equipment should be returned in the same condition as it was received. Equipment and uniforms should be cleaned and washed before being returned. Students are expected to make arrangements to have torn or ripped clothing repaired prior to turning it in to the coach.

12) Earning an Athletic Block Letter / Participation Certificate and Attending Banquet/s

i) A student/athlete must meet the following requirements: (a) Complete the entire season, including post season if applicable, in good

standing. (b) All equipment returned. (c) All debts cleared with Student Accounts. (d) Types of awards are determined at each individual site.

13) Coaches Office Hours

i) Our continuing effort to establish and maintain clear lines of communication between the Athletic Department Staff and the parents/guardians of our student/athletes, the coaching staff will set up a specific time and day to meet about concern/s that arise. Please do not attempt to confront a coach before or after a contest or practice. Those can be emotional times for both the parents and the coaches. Meetings of that nature, and at those times, do not promote resolution. The following guidelines will help to ensure the concept of a productive and positive experience:

(a) Parents can use this time to ask questions and obtain information. (b) Coach will discuss what the student/athlete needs to work on or improve (c) Coach will only talk to a parent/guardian about his/her own child. (d) Playing time will not be discussed! (e) If satisfaction is not obtained, the parent/guardian should then contact the

varsity level coach or the athletic director. (f) Parents who verbally abuse a coach may be liable for

harassment/slander/defamation of character. ii) It is the intent of the Athletic Department to provide an avenue for meaningful

dialogue and communication between coaches and parents. Working together we can and will accomplish great things.

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Nondiscrimination

The Governing Board is committed to providing equal opportunity for all individuals in education. District programs, activities, and practices shall be free from discrimination based on race, color, ancestry, national origin, ethnic group identification, age, religion, marital or parental status, physical or mental disability, sex, sexual orientation, gender, gender identity or expression, or genetic information; the perception of one or more of such characteristics; or association with a person or group with one or more of these actual or perceived characteristics.

Bullying

The Governing Board believes that all students have the right to be educated in a positive learning environment free from disruptions. Students shall be expected to exhibit appropriate conduct that does not infringe upon the rights of others or interfere with the school program while on school grounds, while going to or coming from school, while at school activities, and while on district transportation. Prohibited student conduct includes, but is not limited to harassment of students or staff, including bullying, intimidation, cyberbullying, hazing or initiation activity, ridicule, extortion, or any other verbal, written, or physical conduct that causes or threatens to cause bodily harm or emotional suffering. BP 5131

Sexual Harassment

The Governing Board is committed to maintaining a learning environment that is free of harassment. Board Policy 5145.7 prohibits the unlawful sexual harassment of any student by any employee, student, or other person at school or at any school-related activity. The District is committed to taking serious, immediate and appropriate action with respect to violations of sexual harassment policy. Students shall be assured that they need not endure any form of sexual harassment. They shall further be assured that they need not endure, for any reason, any harassment that impairs the educational environment or a student’s emotional well being at school. Should a student believe that he/she has been subjected to sexual harassment, he/she shall file a complaint in accordance with the guidelines outlined under the Uniform Complaint Procedures. Students can be assured that the District will not tolerate retaliation as a result of the filing of a complaint. Any student who engages in the sexual harassment of anyone at school or a school related activity shall be subject to disciplinary action.

Uniform Complaint Procedure

It is the goal of the Folsom Cordova Unified School District to ensure compliance with applicable state and federal laws and regulations governing educational programs. The District shall follow the Uniform Complaint Procedure when addressing complaints alleging unlawful discrimination on the basis of actual or perceived ancestry, color, ethnic group identification, national origin, race, religion, sex, gender (including sexual harassment), sexual orientation, or physical and/or mental disability in any program or activity that receives or benefits from state financial assistance or for the alleged failure to comply with state or federal law when addressing complaints regarding adult basic education, consolidated categorical aid programs, migrant education, vocational education, child care and development programs, child nutrition programs and special education programs. More detailed information regarding the Uniform Complaint Procedure is contained in the Folsom Cordova Unified School District Parent’s Rights and Responsibilities Handbook. If you have questions regarding the Uniform Complaint Procedure, please contact the Human Resources department at (916) 294-9002.

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California Interscholastic Federation Code of Conduct for Interscholastic Student-Athletes

Interscholastic athletic competition should demonstrate high standards of ethics and sportsmanship and promote the development of good character and other important life skills. The highest potential of sports is achieved when participants are committed to pursuing victory with honor according to six core principles: trustworthiness, respect, responsibility, fairness, caring, and good citizenship (the "Six Pillars of Charactersm"). This Code applies to all student- athletes involved in interscholastic sports in California. I understand that, in order to participate in high school athletics, I must act in accord with the following:

TRUSTWORTHINESS

1. Trustworthiness — be worthy of trust in all I do. Integrity — live up to high ideals of ethics and sportsmanship and always pursue victory with honor; do what’s right even when it’s unpopular or personally costly. Honesty — live and compete honorably; don’t lie, cheat, steal or engage in any other dishonest or unsportsmanlike conduct. Reliability — fulfill commitments; do what I say I will do; be on time to practices and games. Loyalty — be loyal to my school and team; put the team above personal glory.

RESPECT

2. Respect — treat all people with respect all the time and require the same of other student-athletes. 3. Class — live and play with class; be a good sport; be gracious in victory and accept defeat with dignity; give fallen

opponents help, compliment extraordinary performance, show sincere respect in pre- and post-game rituals. 4. Disrespectful Conduct — don’t engage in disrespectful conduct of any sort including profanity, obscene gestures,

offensive remarks of a sexual or racial nature, trash-talking, taunting, boastful celebrations, or other actions that demean individuals or the sport.

5. Respect Officials — treat contest officials with respect; don’t complain about or argue with official calls or decisions during or after an athletic event.

RESPONSIBILITY

6. Importance of Education — be a student first and commit to getting the best education I can. Be honest with myself about the likelihood of getting an athletic scholarship or playing on a professional level and remember that many universities will not recruit student-athletes that do not have a serious commitment to their education, the ability to succeed academically or the character to represent their institution honorably.

7. Role-Modeling — Remember, participation in sports is a privilege, not a right and that I am expected to represent my school, coach and teammates with honor, on and off the field. Consistently exhibit good character and conduct yourself as a positive role model. Suspension or termination of the participation privilege is within the sole discretion of the school administration.

8. Self-Control — exercise self-control; don’t fight or show excessive displays of anger or frustration; have the strength to overcome the temptation to retaliate.

9. Healthy Lifestyle — safeguard your health; don’t use any illegal or unhealthy substances including alcohol, tobacco and drugs or engage in any unhealthy techniques to gain, lose or maintain weight.

10. Integrity of the Game — protect the integrity of the game; don’t gamble. Play the game according to the rules.

FAIRNESS

11. Be Fair — live up to high standards of fair play; be open-minded; always be willing to listen and learn.

CARING

12. Concern for Others — demonstrate concern for others; never intentionally injure any player or engage in reckless behavior that might cause injury to myself or others.

13. Teammates — help promote the well-being of teammates by positive counseling and encouragement or by reporting any unhealthy or dangerous conduct to coaches.

CITIZENSHIP

14. Play by the Rules — maintain a thorough knowledge of and abide by all applicable game and competition rules. 15. Spirit of rules — honor the spirit and the letter of rules; avoid temptations to gain competitive advantage through

improper gamesmanship techniques that violate the highest traditions of sportsmanship.

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Checklist of Required Forms (Please print legibly on all forms)

The following forms need to be turned in to the athletic director no less than three weeks prior to try outs.

Acknowledgement of Athletic/Extra Curricular Handbook o Parent/guardian signature o Student signature o High School Only – Transfer students must mark the Transfer Student Box

NOTE for High School Only: If the athlete is a new student to the school and has attended 15 days or more of school at another high school, the “Yes” box must be marked next to Transfer Student on the Acknowledgement of Athletic/Extra Curricular Handbook Form. The Athletic Director will then contact the athlete’s parent about transfer eligibility requirements.

Agree ment for Team/Extra Curricular Participation (2 pages) o

o o o

A separate form is required for each sport/club Contains current medical insurance information Parent/guardian signature Student signature

Sports Physical Exam Form o One per school year with all sports listed (dated no earlier than June of the current year) o Parent/guardian completes upper portion, Part I and signs o Part II completed by MD only (no chiropractor or physical therapist)

Concussion and Head Injury Information Sheet

-applies to any interscholastic, intramural, or other sport or physical recreation program (including cheer/dance teams and band) sponsored or approved by the District, including middle school and elementary school programs

o Parent/guardian signature o Student signature

Transportation Fee

- please include athlete’s name and sport on check o Per sport

Steroid Agreement

- one per year and applicable to all sports o Parent/guardian signature o Student signature

Emergency Card

- filled out by parent/guardian and carried by coach at all practices and events o Parent/guardian signature o Academically eligibility: 2.0 GPA

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Checklist of Required Forms

(Please print legibly on all forms)

Automobile Use & Transportation Forms

For those occasions when a bus is not available for an off campus practice or event, a coach/teacher may make arrangements for parent drivers. However, parent drivers must be cleared as a Volunteer Category 2. See the Volunteer Category 2 requirements on your schools website.

Volunteer/Personal Automobile Use Form

Required if:

- Parent/guardian will be driving students other than their own, to or from events; for athletics, driving to an event will only be on rare occasions

o Must include copy of driver’s license o Must include declarations page of auto insurance policy that indicates coverage levels o Must be updated as policy expires o Parent/guardian or designated driver is required to sign the student out PRIOR to leaving the

event

Student Personal Automobile Use Form

Required if:

- Student is requesting to drive him/herself to an off campus practice or event, will not be using District provided Transportation

- Athletes’ driving to an event will only be on rare occasions

o Parent/guardian signature o Student signature o Student driver is required to sign out PRIOR to leaving the event

NOTE - The Athletic Director or designee must give prior approval for a student to drive themselves

- NO additional students are permitted in the vehicle

Alternate Student Transportation Form

Required if:

- Parent/guardian designates a specific adult to drive their son or daughter; will not be using transportation provided by the District

- The designated adult must agree and be listed on this form; they are also required to sign the student out PRIOR to leaving the event

- Student who has completed a Student Personal Automobile Use Form and has received prior approval by the Athletic Director or designee to drive themselves

o Parent/guardian signature o Student signature o Supervising Employee signature required (school to provide) o Designated driver is required to sign the student out PRIOR to leaving the event

Parent/Guardian Driving Their Own Son/Daughter and No Other Students

- For a parent/guardian who will be driving their own son/daughter and no other students to an off campus practice or event, no additional automobile forms are required but advance notice is required to be given to the coach/teacher

o Parent/guardian driver is required to sign the student out PRIOR to leaving the event

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Revised August 2012

Acknowledgment of Athletic/Extra Curricular Handbook Form

Name

(Last) (First)

List Sport(s)

Birth Date / / Age Grade Female Male

Parent / Guardian Name Father Mother

Cell Phone Number Father Mother

Father Email @

Mother Email @

Home Address City Zip

Have you ever been enrolled and attended another high school even for one day? Yes No

Consent Statements – Please read carefully and sign below.

I hereby give my consent for the above-named student to participate in athletics/extra curricular activities.

I hereby give my consent for the above-named student to have his/her picture and/or statistics published. This may include print/electronic media.

I hereby authorize the FCUSD or a representative to transport and supervise the above- named student on any trip.

I hereby give my consent, in case this student is injured or becomes ill, for the school and/or its representative to secure medical aid, ambulance transportation, and for the medical agency to render treatment.

I hereby give my consent to the team physician, emergency doctor, nurse, athletic trainer, teacher and/or coach to apply first aid treatment until the family doctor can be contacted.

I, as a student athlete, have read and will adhere to the Code of Conduct for Interscholastic Student Athletes.

I, as a parent/guardian, have read and will adhere to the Code of Conduct for parents/guardians.

I understand there is a Transportation Fee for each sport that the student participates.

WE HAVE READ AND UNDERSTAND ALL OF THE RESPONSIBILITIES AS OUTLINED IN BOTH THE STUDENT/PARENT HANDBOOK AND ANY ADDITIONAL GUIDELINES (If applicable) ATTACHED BY THE COACH OR TEACHER.

Parent/Guardian Signature Date

Student Signature Date

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

Revised August 2012

AGREEMENT FOR TEAM/EXTRA CURRICULAR PARTICIPATION [Including Waivers and Releases of Potential Claims and Statement of Other Obligations]

All sections of this Agreement must be completed, with signed original delivered to the School Office before a Student will be allowed to participate in any manner in the Team Activities defined below.

A separate Agreement is required for each Team in which the Student may participate.

Additional Required Forms – Concussion and Head Injury Information Sheet & Sports Physical Examination Form

Student: Address:

Grade: DOB:

School: Telephone:

Team(s):

In consideration of the Student’s ability to participate on a Team [including any Sport, Cheerleading, Dance, or Marching Band], including try-outs, practices, pre-season or seasonal strength or training sessions or training camps, or actual participation in Team events, shows, performances, or competitions, or the traveling to or from any of these activities (“Team Activities”), the Student and Parent/Legal Guardian (“Adult”) signing this Agreement agree as follows:

1. It is a privilege, not a right, to participate in extra-curricular activities, including Team Activities. The privilege may be

revoked at any time, for any reason that does not violate Federal or State law or District policies or procedures. There is no guarantee that the Student will make a Team, remain on a Team, or actively participate in Team events, shows, performances, or competitions. Such matters shall remain exclusively within the judgment and discretion of the supervising District employee or volunteer coach.

2. The Student and the Adult understand the nature of the Team, including the inherent or potential risks of Team Activities. The Student is in sufficiently good health and physical condition to participate in Team Activities, and voluntarily wishes to participate in Team Activities. Before participating in any Team Activity, a properly executed Sports Physical Examination Form and Concussion Head Injury Sheet shall be submitted to the school office (valid for one academic year, Fall/Winter/Spring Activities).

3. The Student shall comply with the instruction and directions of Team Activity teachers, coaches, supervisors, chaperones, and instructors. During the Student’s participation in Team Activities, as well as academic and/or other school activities, the Student shall comply with all applicable Codes of Conduct. The Student shall also generally conduct himself/herself at all times in keeping with the highest moral and ethical standards so as to reflect positively on himself/herself, the Team and the District. Failure to meet these obligations may, in the discretion of the District, result in removal from the Team and/or Team Activities. Should the Student’s violation of these obligations result in bodily injury or property damage, the Adult agrees to (a) pay to restore or replace the damaged property, (b) pay for bodily injury damages to an individual, and (c) defend, protect and hold the District harmless from such claims.

4. Team Activities contain potential risks of harm or injury, including harm or injury that may lead to permanent or serious physical injury to the Student, including paralysis, brain injury, or death (“Injuries”). Injuries might arise from the Student’s actions or inactions, the actions or inactions of another Student or participant in a Team Activity, or the actual or alleged failure by District employees, agents or volunteers to adequately coach, train, instruct, or supervise Team Activities. Injuries might also arise from an actual or alleged failure to properly maintain, use, repair, or replace physical facilities or equipment available for Team Activities. Injuries might also arise from undiagnosed, improperly diagnosed, untreated, improperly treated, or untimely treated actual or potential physical conditions or Injuries, whether or not caused by or related to the Student’s participation in Team Activities. All such risks are deemed to be inherent to the Student’s participation in Team Activities. To the fullest extent allowed by law, the Student and Adult therefore also fully assume all such risks and waive and release any potential future claim they might otherwise have been able to assert against the District and any Board Member, employee, agent, or volunteer of the District (“Released Parties”), including any claim that could otherwise have been made on behalf of the Student or any parent, administrator, executor, trustee, guardian, assignee or family member. The Student and Adult further understand that Team Activities and transportation to and/or from Team Activities are “field trips” for which there is immunity from liability pursuant to Education Code Section 35330.

5. If the Student believes that an unsafe condition or circumstance exists, or otherwise feels or believes that continued participation in a Team Activity might present a risk of Injury, the Student will immediately discontinue further participation in the Team Activity, notify School personnel of the Student’s belief, and notify a parent or guardian of the Student’s belief. The parent or guardian shall thereafter prevent the Student from participating in the Team Activity until the unsafe condition or circumstance is addressed or remedied to their satisfaction.

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

6. Emergency medical information regarding the Student is on file with the District and is current. The Adult agrees to provide

updated medical information during the course of the Student’s participation in Team Activities. If an injury or medical emergency occurs during Team Activities, District employees, agents or volunteers have my express permission to administer or to authorize the administration of urgent or emergency care, including the transportation of the Student to an urgent care or emergency care provider. In such circumstances, notice to me and/or the Emergency Contact of the injury or medical emergency may be delayed. Therefore, any urgent or emergency care provider has my express authority to conduct diagnostic or anesthetic procedures, and/or to provide medical care or treatment (including surgery), as they may deem reasonable or necessary under all existing circumstances. All costs and expenses associated with such care are solely my responsibility. An Adult can only withhold this authorization by filing an Objection to Medical Care (Education 49407) that is based on their personally held religious beliefs.

7. Education Code Section 32221.5 requires us to notify you that: Under state law, school districts are required to

ensure that all members of school athletic teams have accidental injury insurance that covers medical and hospital expenses. This insurance requirement can be met by the school district offering insurance or other health benefits that cover medical and hospital expenses. Some pupils may qualify to enroll in no- cost or low-cost local, state, or federally sponsored health insurance programs. Information about these programs may be obtained by calling the District. Education Code Section 32221 requires that such insurance cover medical and hospital expenses resulting from bodily injuries in one of the following amounts: (a) a group or individual medical plan with accident benefits of at least $200 for each occurrence and major medical coverage of at least $10,000, with no more than $100 deductible and no less than 80% payable for each occurrence; (b) group or individual medical plans which are certified by the Insurance Commissioner to be equivalent to the required coverage of at least $1,500; or (c) at least $1,500 for all such medical and hospital expenses. You may meet this obligation in one of two ways:

Option 1: Private medical insurance/Medical. If this option is selected, please provide (Name of Insurer/Provider) and (Policy number/Identifying number),

(list coverage dates or “continuous”). The Adult agrees that the Student is covered, and will remain covered during the length of the Team season and that coverage exists in the amounts required by Section 32221.

Option 2: Purchase insurance meeting the requirements of Section 32221, for the period during which the Student is participating on the Team, through a coverage provider made available through the District [please contact the District to gain additional information regarding this program]. If you are financially unable to pay for such insurance, a payment waiver can be submitted [forms seeking this waiver are also available from the District] and, if no other alternate funding is available through private or charitable organizations, the District will obtain financing for, or provide, the required coverage.

8. Employees, agents or volunteers of the District, members of the press or media, or other persons who may attend or participate in Team Activities, may photograph, videotape, or take statements from the Student. Such photographs, videotapes, recordings, or written statements may be published or reproduced in a manner showing the Student’s name, face, likeness, voice, thoughts, beliefs, or appearance to third parties, including, without limitation, webcasts, television, motion pictures, films, newspapers, yearbooks, and magazines. Such published or reproduced items, whether or not for a profit, may be used for security, training, advertising, news, publicity, promotional, informational, or any other lawful purpose. We authorize and consent to any such publications or reproductions, without compensation, and without reservation or limitation.

9. This Agreement is to be broadly construed to enforce the purposes and agreements set forth above, and shall not be construed against the Released Parties solely on the basis that this Agreement was drafted by the District. If any part of this Agreement is deemed invalid or ineffective, all other provisions shall remain in force. No oral modification of this Agreement, or alleged change or modification of its terms by subsequent conduct or oral statement is allowed. This Agreement contains the sole and exclusive understanding of the parties, with no other representation relied upon by the Adult or Student in determining whether to execute this Agreement or in agreeing to participate in Team Activities.

AS THE ADULT SIGNING BELOW: (1) I AM GIVING UP SUBSTANTIAL ACTUAL OR POTENTIAL RIGHTS IN ORDER TO ALLOW THE STUDENT TO PARTICIPATE IN TEAM ACTIVITIES; (2) I HAVE SIGNED THIS AGREEMENT WITHOUT ANY INDUCEMENT OR ASSURANCE OF ANY NATURE, AND WITH FULL APPRECIATION OF THE RISKS INHERENT IN TEAM ACTIVITIES; (3) I HAVE NO QUESTION REGARDING THE SCOPE OR INTENT OF THIS AGREEMENT; (4) I, AS A PARENT OR LEGAL GUARDIAN, HAVE THE RIGHT AND AUTHORITY TO ENTER INTO THIS AGREEMENT, AND TO BIND MYSELF, THE STUDENT, AND ANY AND ANY OTHER FAMILY MEMBER, PERSONAL REPRESENTATIVE, ASSIGN, HEIR, TRUSTEE, OR GUARDIAN TO THE TERMS OF THIS AGREEMENT AND I HAVE EXPLAINED THIS AGREEMENT TO THE STUDENT, WHO UNDERSTANDS HIS/HER OBLIGATIONS.

Printed Name of Parent/Guardian Signature Date

As the Student, I understand and agree to all of obligations placed on me by this Agreement.

Printed Name of Student Signature Date

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

FOLSOM CORDOVA UNIFIED SCHOOL DISTRICT SPORTS PHYSICAL EXAMINATION FORM

Revised August 2012

PART 1 (TO BE COMPLETED BY A PARENT OR LEGAL GUARDIAN) LAST NAME FIRST NAME GRADE

BIRTHDATE FALL SPORT WINTER SPORT SPRING SPORT STUDENT ID NUMBER

PART 1 -- HEALTH HISTORY (Must be Completed by Parent/Guardian Prior to the Examination) Yes No Has this student had:

1. Chronic or recurrent illness? 16. Injuries requiring medical care or treatment? 2. Illness lasting over 1 week? 17. Neck or back pain or injury? 3. Hospitalizations or Surgeries? 18. Knee pain or injury? 4. Nervous, psychiatric, or neurologic condition? 19. Shoulder or elbow pain or injury? 5. Loss or nonfunctioning of organs (eye, kidney, 20. Ankle pain or injury?

liver, testicle) or glands? 21. Other joint pain or injury? 6. Allergies (medicines, insect bites, food)? 22. Broken bones (fractures)? 7. Problems with heart or blood pressure? Yes No Does this student presently: 8. Chest pain or significant or severe shortness of 23. Wear eyeglasses or contact lenses?

breath during or after exercise? 24. Wear dental bridges, braces or plates? 9. Dizziness or fainting with exercise? 25. Take any medications? (List below): 10. Fainting, bad headaches or convulsions? Yes No Further history: 11. Potential concussion or loss of consciousness? 26. Birth defects (corrected or not)? 12. Heat exhaustion, heatstroke, or other problems 27. Death of a parent or grandparent less than 40

managing or responding to heat? years of age due to medical cause or condition? 13. Racing heartbeat, skipped or irregular heartbeats, 28. Parent or grandparent requiring treatment for

or heart murmur? heart condition less than 50 years of age? 14. Seizures or seizure disorders? 29. Been seen by a physician on an emergency or 15. Severe or repeated instances of muscle cramps? urgent basis in the last 12-months?

Date of last known tetanus (lockjaw) shot: Date of last complete physical examination:

Explain all “YES” answers. Describe any other fact that should be disclosed prior to the examination (use reverse of form if needed):

PARENT/GUARDIAN’S AUTHORIZATION: I authorize the health care provider to perform a Sports Physical Evaluation on the student. The information set forth above is complete and accurate. I presently know of no reason why the student cannot fully and safely participate in the listed sports. For Sports Physical Evaluations that may be performed by District volunteers, I understand the evaluation is a screening evaluation only, and that I must address all health care concerns with the Student’s personal physician or health care provider. PRINT NAME OF PARENT OR GUARDIAN SIGNATURE OF PARENT OR GUARDIAN

ADDRESS WORK PHONE HOME PHONE DATE

REGULAR PHYSICIAN’S NAME OFFICE PHONE PART 2 – MEDICAL EVALUATION (TO BE COMPLETED BY THE EXAMINING HEALTH CARE PROVIDER)

This Evaluation Can Only be Performed by Medical Doctors (MDs), Doctors of Osteopathy (DOs), Physician’s Assistants (P.A.s), and Nurse Practitioners (N.P.s)

NORMAL ABNORMAL (Describe) (May be contained on Provider’s Form) Eyes/Ears/Nose/Throat Height: Weight: Heart, lungs, pulmonary function Pulse: After Ex: Abdomen, genital/hernia (males) BP: Skin and Musculoskeletal: Recommendation:

Unlimited participation Limited participation/specific

sports, events or activities Clearance withheld pending

further testing/evaluation No athletic participation One of the above MUST be checked.

a. Neck/Spine/Shoulders/Back b. Arms/Hands/Fingers c. Hips/Thighs/Knees/Legs d. Feet/Ankles

Neurologic Screening Exam (NSE)/ Concussion Screening Evaluation (only if needed based on above info.)

Comments:

PRINT NAME OF PHYSICIAN PHYSICIAN’S SIGNATURE DATE

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

Revised August 2012

FOLSOM CORDOVA UNIFIED SCHOOL DISTRICT CONCUSSION AND HEAD INJURY INFORMATION SHEET

Student: Address:

Grade: Telephone:

School: School Year: DOB:

Pursuant to Education Code Section 49475, before a Student may try-out, practice, or compete in any District-sponsored extracurricular athletic program, including interscholastic, intramural, or other sport or recreation programs (including cheer/dance teams and marching band), but excluding physical education courses for credit, the student and parent/legal guardian must review and execute this Concussion and Head Injury Information Sheet. Once signed, the Sheet is good for one academic year (Fall through Spring) and is applicable to all athletic programs in which the Student may participate.

IMPORTANT INFORMATION REGARDING CONCUSSIONS

If a Student is suspected of sustaining a concussion or head injury during an athletic activity, the Student shall be immediately removed from the activity. The Student will not be allowed to resume any participation in the activity until he/she has been evaluated by a licensed health care provider (MD or DO for CIF-governed interscholastic sports; MD, DO, nurse practitioner, or physician’s assistant for all other sports/athletic activities), who must affirmatively state (1) that he/she has been trained in concussion management and is acting within the scope of his/her licensed medical practice, and (2) the student has been personally evaluated by the health care provider and has received a full medical clearance to resume participation in the activity. By law, there can be no exceptions to this medical clearance requirement.

Depending on the circumstances of a particular practice or game, a supervising referee/umpire, coach/assistant coach, athletic trainer, or attending health care provider may determine that a student should be removed from an activity based on a suspected or potential concussion or head injury. The following guidelines will be used: (1) in the case of an actual or perceived loss of consciousness, the student must be immediately removed from the activity; (2) in all other cases, standardized concussion assessment tools (e.g., Sideline Concussion Assessment Tool (SCAT-II), Standardized Assessment of Concussion (SAC), or Balance Error Scoring System (BESS) protocol) will be used as the basis to determine whether the student should be removed from the activity. For the safety and protection of the student, once a supervising individual makes a determination that a student must be withdrawn from activity due to the potential existence of a concussion or head injury, no other coach, player, parent or other involved individual may overrule this determination.

Once a student is removed from an activity, the parent/guardian should promptly seek a medical evaluation by a licensed health care provider, even if the student does not immediately describe or show physical symptoms of a concussion (headache, pressure in the head, neck pain, nausea or vomiting, dizziness, blurred vision, balance problems, sensitivity to light or sound, feeling “slow,” “foggy,” or “not right,” difficulty with concentration or memory, confusion, drowsiness, irritability or emotionality, anxiety or nervousness, or difficulty falling asleep). If the student reports or shows any of these symptoms, immediate medical health care should be obtained. If a parent or legal guardian is not immediately available to make health care decisions, the District reserves the right to have the student taken for emergency or urgent evaluation or medical care in keeping with the authorization contained in the Agreement for Team Participation.

Student Parent/Guardian

Signature Signature

Dated: Dated:

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

Revised August 2012

AGREEMENT NOT TO USE PERFORMANCE ENHANCING DRUGS (Including Authorization for Drug Testing as Allowed by Law)

Student Name

School

Birthdate Grade

As a condition of membership in the California Interscholastic Federation (“CIF”), the District was required to adopt policies that prohibit the use and abuse of androgenic/anabolic steroids. (CIF By-Law 523). Failure to comply with these policies can result in CIF suspending the sport from competitions and/or imposing other fines or consequences. In order to comply with CIF and District requirements, the student athlete and at least one parent/legal guardian must sign this Agreement Not to Use Performance Enhancing Drugs, noting their compliance with the following requirements.

1. The student shall not use androgenic/anabolic steroids, human growth hormone, erythropoietin (EPO),

beta-blockers, stimulants, or diuretics except when under the care of a licensed physician who has issued a current prescription to the student for such drugs in response to an identified medical condition.

2. The student shall not possess or distribute androgenic/anabolic steroids, human growth hormone,

erythropoietin (EPO), beta-blockers, stimulants or diuretics at any time. If the student has a prescription for such medications, he/she shall follow the District’s Medication Management Policies and Procedures.

3. If a student is found to have used, possessed or distributed androgenic/anabolic steroids, human growth

hormone, erythropoietin (EPO), beta-blockers, stimulants or diuretics not in keeping with these requirements, the student will face potential immediate suspension from the team and may face further discipline, up to and including suspension or expulsion from school. If the student becomes aware of facts indicating that another student has violated these rules, the student shall immediately notify the head coach, the school principal, or the athletic director.

4. If there is an allegation that the student has violated these policies, the District is authorized to conduct

an oral or urine test, as may be appropriate, to test for prohibited substances. The District is also authorized, as allowed by law, to conduct random drug tests, which would include tests intended to determine the presence of these substances, as well as other drugs (marijuana, cocaine, methamphetamines, etc.), the use of which by students is barred by law and District policy. All such testing will be at the cost of the District, with a copy of the results mailed to the parent/legal guardian. Any positive drug test result may result in discipline as authorized by District policy.

Student Signature: Date: _

Parent/Guardian Signature: Date:

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

HEALTH HISTORY YES NO Kidney Injuries Heart Condition or Disease Diabetes Asthma Allergic to Bee Stings Prior Serious Head Injury or Concussion

FOLSOM CORDOVA UNIFIED SCHOOL DISTRICT Athletic/Extra Curricular Participation

EMERGENCY INFORMATION

Student Name:

Grade: Birth Date: Age:

Parent/Guardian Name:

Address:

Home Phone: Father’s Cell Phone: Mother’s Cell Phone:

Father’s Email: Mother’s Email:

In an emergency if parents cannot be contacted, please notify:

Name: Home Phone:

Relationship: Cell Phone:

In emergency cases, do you give permission for the team physician, trainer, and/or coach to apply first aid treatment until the family doctor can be contacted? Yes No

Family Doctor: Phone Number:

Student’s Insurance Company:

DATE OF LAST TETNUS SHOT:

Does student carry an inhaler? Yes No

While competing does the student wear: Glasses Contacts Knee or Ankle Brace Required

Other medical conditions not listed above: Allergies to medications or other:

School Use Only:

Student is academically eligible and has a 2.0 GPA or above: Yes No Student was cleared to participate in athletics on

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Signature: Name:

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THIS FORM TO BE HELD ON FILE IN THE MAIN OFFICE FOR A PERIOD OF ONE (1) YEAR FROM THE DATE OF THE CURRENT SCHOOL YEAR

Revised August 2012

BE ST P R AC T I C E STANDAR DS R EQUI R ED BY DI STRICT

THE DRIVER OF A VEHICLE OPERATED BY A PARENT, VOLUNTEER OR STUDENT SHALL ENSURE PRIOR TO DRIVING:

• That he/she has complied with all obligations of the Volunteer/Personal Automobile Use or Student

Personal Automobile Use Forms. • That the vehicle registration and insurance policy is current and contained in the vehicle so that it will be

immediately available to District or law enforcement personnel upon request. • That the vehicle is in full working order (lights, horn, tires, brakes, seat belts, car seats, etc.) and that the

vehicle has sufficient gasoline/power to make it to the agreed destination. • That the driver has the full names of each passenger in the vehicle and that the each passenger is

authorized to be in the vehicle under District policies. Inclusion of unauthorized passengers is grounds for revocation of the authorization to drive.

• That the driver is aware of the approved and/or safe paths of travel to the agreed destination, including any

issues or concerns regarding roadway safety. • That unnecessary or unscheduled stops or detours must be avoided and should generally be limited to

emergency situations that could not have been foreseen or avoided. Personal errands are not permitted and may result in a revocation of driving authorization.

• That due to the need to focus on the safety of passengers and members of the public, and in order to ensure

that you are not distracted from carrying out your primary duty to first protect students who may be under your care, custody or control, you will not have other non-district personnel (except other approved chaperones), non-students (including other children not participating in an event), or other guests as passengers in the vehicle.

• That you will only carry passengers for which there is an actual seat belt or booster/car seat, regarding of

the size of the vehicle or its potential capacity. • In case of an emergency or other urgent situation, you will immediately notify the event supervisor and/or

your supervisor after contacting 911 (if appropriate). It remains your obligation to at all times timely and properly comply with emergency directions.

• If you have questions regarding your rights, duties, or responsibilities, contact the athletic director or

school office.

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2015-2016 VOLUNTEER PERSONAL AUTOMOBILE USE FORM

[One Form Required for Each Driver to be Approved]

Thank you for volunteering your time, and your automobile, to help transport our Students to off-site events or activities. In order to protect the health and safety of our Students, our District requires that anyone (employee or volunteer) using their personal automobile to transport Students to and from sanctioned activities must receive prior approval. Before we can issue such approval, certain information must be obtained at least fifteen (15) days before you transport our Students.

You must also agree to abide by certain rules regarding the operation of the vehicle as set forth below.

REQUIRED INFORMATION Name of Driver: Calif. Driver’s License No. & Exp. Date: Vehicle(s) Year/Make/Model: Vehicle(s) License Plate No.: Insurance Carrier: Policy Number and Expiration Date: Liability Coverage Limits:

We also require a photocopy of (a) your Driver’s license, and (b) your Insurance Policy Declarations Page. Should your Driver’s License or Insurance Policy expire during the school year, updated photocopies showing their renewal are required before you will again be eligible to transport Students. By signing below, you are also authorizing the District to (a) obtain a copy of your Driver Record History and status of your Driver’s License, (b) conduct a criminal background check, and (c) contact your insurance company to confirm your insurance status. Also, please also be advised, that pursuant to Insurance Code Section 11580.9(d), in the case of an accident, your insurance will provide the primary coverage for any resulting bodily injury or property damage. The District’s automobile liability coverage will apply, if at all, only after your insurance coverage is exhausted through the payment of covered claims. The District does not cover, nor is the District responsible for, comprehensive, uninsured motorists, or collision coverage for your vehicle.

VEHICLE SAFETY AND TRANSPORTATION PROCEDURES AND REQUIREMENTS

For the safety of our Students, in signing below, you are also agreeing to the following rules and requirements:

1. I will not operate an automobile while impaired, whether due to alcohol, drugs (prescription or nonprescription), lack of sleep, or distraction of any kind. I will at all times comply with California law regarding proper operation of the Vehicle, including compliance with all speed limits and posted signs and placards.

2. I will not transport Students in a Vehicle I have reason to believe may be mechanically unsafe or that may become unsafe due to weather or other natural conditions. I will not transport Students unless I have a working seatbelt for each Student, with seatbelts to be used at all times by myself and all transported Students. The Vehicle(s) may be inspected by District representatives.

3. I am over the age of 21 and will be the sole driver of the Vehicle for any given activity, event, or competition. I will not let anyone other than myself and authorized Students ride in the Vehicle. However, I may seek written permission from the District to allow another child of mine to ride in the Vehicle to a specific activity, event, or competition if the destination involves an activity, event or competition generally available to the public or, at my expense and with District permission, I can purchase admittance for such other child.

Printed Name Signature Date

Date Received by District: Received by:

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ALTERNATE STUDENT TRANSPORTATION FORM Students participating in off-campus District-sponsored activities, including, but not limited to, practices, games, meetings, competitions, and conferences (“Events”), are required to travel on school buses or by other District-designated methods of transportation. Under special circumstances, with the District’s prior written approval, Students may be transported to and from Events (a) by a parent/guardian or other designated adult, or (2) by himself/herself. Under no circumstances may Students be transported in a vehicle driven by another student or anyone under 21 years of age.

Before the District grants a request for alternate transportation, this Student Alternate Transportation Form must be submitted to the School Office after it has been signed by the Student, the Student’s parent/ legal guardian, and the District employee supervising the Event. Before the Student Alternate Transportation Form will be accepted and approved by the School Office, the individual who will transport the Student must also complete and file with the School Office an acceptable (a) Personal Automobile Use Form (for parents/ guardians/designated adults) or (b) Student Personal Automobile Use Form (if the Student intends to drive himself/herself to Events).

If the required Forms are not submitted to and accepted by the School Office 48-hours before an Event, the Student must be transported to and from the Event through normal District-sponsored methods. A Student not complying with these provisions will not be allowed to attend or participate in the Event. Name of Student: Event(s): Each approved Event or series of Events must be listed:

Date(s): Reason for Request:

Name of Designated Driver(s): Student and/or Designated Adult(s)

I/we agree that the designated drivers and vehicles to be used are not covered under the District’s automobile liability coverage. The Student, his/her parent(s)/guardian(s), and/or the driver of the vehicle are solely responsible for damage or injury to others. I/we also agree that the Student and anyone else in the vehicle assume their own risk of harm, injury or death arising from this choice for alternate transportation. The Student, his/her parent(s)/legal guardian(s), and/or the vehicle driver further agree to hold the District and its officers, employees and volunteers free from any liability arising from this alternate transportation, agreeing also to defend and indemnify them against any resulting claim.

Printed Name of Student Signature Date Printed Name of Parent/Guardian

Signature Date

Printed Name of Supervising Employee

Signature Date

Date Received by District: Received/Approved by:

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2015-2016 STUDENT PERSONAL AUTOMOBILE USE FORM

Students participating in off-campus District-sponsored activities, including, but not limited to, practices, games, meetings, competitions, and conferences (“Events”), are required to travel on school buses or by other District-designated methods of transportation. At the District’s sole discretion, after a separate Student Alternate Transportation Form has been properly executed, Students may transport themselves to and from designated activities. Before District authority is granted to the Student to drive to and from District-sponsored events, this Form and its required information must be completed and accepted by the School Office. The District’s permission for the Student to drive to and/or from District-sponsored activities may be revoked or limited at any time, for any reason.

REQUIRED INFORMATION

Name of Student Driver: Calif. Driver’s License No. & Exp. Date: Any License Restrictions: Vehicle(s) to be Driven - Year/Make/Model: Vehicle(s) License Plate No(s).: Insurance Carrier: Policy Number and Expiration Date: Liability Coverage Limits:

With this Form, you must also provide a photocopy of (a) the Student’s Driver’s license, and (b) the Insurance Policy Declarations Page showing that coverage exists for the Student and the vehicle to be driven. Should the Student’s Driver’s License or the Insurance Policy expire during the school year, updated photocopies showing renewal are required before the Student will again be eligible to transport himself/herself to District-sponsored activities.

Neither the Student nor the Student’s vehicle is covered under the District’s automobile liability coverage. By signing this Form, you agree that the Student and his/her parent(s)/legal guardian(s) are solely responsible for any resulting damage or injury to others. You also agree that the Student and his/her parent(s)/legal guardian(s) assume the risk of harm, injury or death to the Student or others, and that by voluntarily allowing the Student to operate his/her own vehicle, the Student and his/her parent(s)/legal guardian(s) will hold the District and its officers and employees free from all liability.

For the safety of our Students, in signing below, you are also agreeing to the following rules and requirements: 1. I/The Student will not operate an automobile while impaired, whether due to alcohol, drugs (prescription or

nonprescription), lack of sleep, or distraction of any kind. I/the Student will at all times comply with California law regarding proper operation of the Vehicle, including compliance with all speed limits and posted signs and placards.

2. I/The Student will not operate an automobile that I/The Student believe, for any reason, is mechanically unsafe or that may become unsafe due to weather or other natural conditions. The automobile will have working seatbelts, which I/the Student will use at all times. The Vehicle(s) may be inspected by District representatives.

3. I/The Student will be the sole driver of the Vehicle. I will not let anyone else, ride in or occupy the Vehicle while traveling to or from any District-sponsored activity, or while I/the Student attend a District-sponsored activity.

By signing below, you are authorizing the District, at its discretion, to (a) obtain a copy of the Student’s Driver Record History and confirm the status of the Student’s Driver’s License, (b) conduct a criminal background check, and/or (c) contact the listed insurance company to confirm the existence of insurance coverage for the Student and the vehicle.

Printed Student Name Signature Date Printed Parent/Guardian Name Signature Date

Date Received by District: Received by:

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