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Mount Saint Mary Academy
Sister Lisa D. Gambacorto, RSM, Ed.S
Directress
Denise E. Materia
Director of Athletics
X4516
Erin Boccher
Athletic Trainer
X5053
Robert Trautner
Athletic Facilities Manager
Mount Saint Mary Academy
1645 Rt. 22
Watchung, NJ 07069-6587
School Phone (908)757-0108
Athletic Fax (908)756-0255
Athletic Schedule
www.highschoolsports.net
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Coaches by Season
Fall
Cross Country Tennis Field Hockey
Matthew DiPretore Matthew Marino Varsity: TBA
Junior Varsity: Michele Mariski
Volleyball Soccer
Varsity: Darek Libucha Varsity: John Campbell
Junior Varsity: Arielle Perez Junior Varsity: Allie Lubcher
Winter
Basketball Swimming Indoor Track
Freshman: Stephen Muratore Kevin Mahoney Matthew DiPretore
Junior Varsity: Michele Mariski Assistant: Allison Mack Assistant: Andre Bridgett
Varsity: Joseph Kozoh
Spring
Lacrosse Softball Track and Field
Varsity: Allison Mack Varsity: Denise Materia Andre Bridgett
Junior Varsity: Christine Frandsen Assistant: Sister Lisa Gambacorto Assistant: Matthew DiPretore
Junior Varsity: Stephen Muratore Assistant: Matthew Marino
ALMA MATER
Mount Saint Mary, we do hail thee
Alma Mater, fond and true:
Loyal daughters, sing your praises,
Raise your colors, gold and blue.
Glory, honor, steadfast loyalty,
Though we roam from shore to shore,
Mount Saint Mary, Alma Mater
Our hearts will love and praise thee evermore,
Mount Saint Mary, Alma Mater
Our hearts will love and praise thee evermore
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Table of Contents
Philosophy/Goals 5
Attendance 5
Athletic Camps 7
Game Cancellations 7
Captains 7
Clubs/Activities 8
Communication 8
Drug Testing/Use Policies 9
Eligibility 10
Equipment/Uniforms 11
Hazing 12
Medical Issues/Injuries 13
Insurance 15
Physical Education 15
Student Pick up 15
Pictures 15
Schedule 15
Sportsmanship 16
Transfers 17
Transportation 18
Try outs 18
Security 19
Varsity Letters/Awards 19
Concussion Policy 22
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Welcome to Mount Athletics! Mount Saint Mary Academy participates in the New Jersey State
Interscholastic Athletic Association, Independent Schools Athletic Association and the Skyland
Conference. We offer a wide variety of sports each season as listed below:
FALL
SPORT VARSITY JV FRESHMEN
CROSS COUNTRY X X X
FIELD HOCKEY X X
SOCCER X X
TENNIS X
VOLLEYBALL X X
WINTER
SPORT VARSITY JV FRESHMEN
BASKETBALL X X X
CHEERLEADING X
SWIMMING X
TRACK X X
SPRING
SPORT VARSITY JV FRESHMEN
LACROSSE X X
SOFTBALL X X
TRACK & FIELD X X X
Preface Participation in Mount Athletics is not a right of all students but rather a privilege afforded to
students that possess ability, positive attitude, cooperative spirit, and desire to represent the
Mount Saint Mary Academy in a positive and respectful way.
The Athletic Department strives to offer a diverse program that will allow for all students willing
to work hard and show commitment to find a place to compete.
Athletics has unique standards and expectations in the areas of academics, training, commitment,
and sportsmanship that must be adhered to.
Our coaching staff is acutely aware of the philosophy of the Mount Athletic program as well as
the values of Mount Saint Mary Academy. We strive to hire the most knowledgeable staff that is
a fit for our school community. All coaches are responsible to uphold and follow the policies
and procedures found in the Coaches’ Handbook. Our coaching staff tries to instill the values
consistent with the philosophy of Mount Saint Mary Academy.
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Philosophy
The Athletic Department of Mount Saint Mary Academy views interscholastic athletics as an
integral part of the total educational process in which student athletes are challenged to develop
their full potential. In our athletic program students have a forum to develop their skills and fine
tune their abilities. In doing so they will experience a sense of self-accomplishment knowing
they have achieved their personal best. Athletes learn to work within a group, develop dedication
to their teams, and make personal sacrifices for the common good.
Athletics, by nature, provide a significant opportunity to instill the qualities of personal integrity,
honesty and self discipline. Competitive athletics demand dedication, excellence, determination
and courage. It takes courage to give 100% of self, have humility in victory and graciousness in
defeat. The athlete puts forth the best of herself and together with her team represents the best of
Mount Saint Mary Academy.
Goals
1. To continue to have a sound athletic program that is representative of the core values of
Mount Saint Mary Academy
2. To develop in each student athlete a sense of pride in oneself, the team, and the school
community
3. To develop in student athletes self control, self discipline, and a strong work ethic.
4. To provide student athletes the opportunity to exhibit good sportsmanship and respect for
others as a means of learning good citizenship.
5. To provide students the opportunity to celebrate successes and experience disappointment
with dignity.
6. To provide significant opportunity for student athletes to work towards achieving goals
demonstrating the skills of cooperation and teamwork.
7. To provide student athletes with experiences that develop problem solving, reasoning,
decision making, and critical thinking skills.
Attendance
Athletic Attendance Successful athletic programs depend on commitment and hard work. To that end Mount Saint
Mary Academy has required that student athletes attend all practices and games. It is important
that athletes understand that they are expected to be loyal to their team and live up to their
commitments.
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Any player that accumulates more than two absences other than school absences, from preseason,
practices or games will be dismissed from the team. The request for an excused absence must be
submitted in writing at least two weeks in advance to the athletic director and will be granted only in
special situations. Any player that misses a game or practice may be subject to reduced playing time or
loss of a starting position as determined by the coach, even if the absence is excused. Students absent due
to illness or injury must bring a doctor’s note upon return. Every student planning to try out for a team
must attend preseason. All fall sports begin on or about August 20rd. Practices and games for all sports
will be scheduled on days that the school is closed and throughout vacations. The winter athletic schedule
will include activities during the Christmas and trimester breaks. Spring sports will have practices and
games over Easter and Memorial Day vacations. No athlete may participate on a Varsity, Junior Varsity
or Freshman team who is unable to attend practices or games over school vacations. This policy includes
all school sponsored events. Individual coaches are not permitted to grant an exemption to this policy. A
school sponsored day event may be excused at the discretion of the Athletic Director in consultation with
the coach.
School Attendance Policy
Team members who are unable to participate due to injury or illness are expected to attend practices or
games when present in school. Team members may not participate in athletics if they are absent from
school. Athletes must be in school by 10:15 A.M. to be eligible to play. Student athletes arriving to
school late will be subject to the disciplinary procedures outlined in the student handbook.
Game Attendance
Team members must remain in attendance at both Varsity and Junior Varsity games at the
discretion of the coach. Coaches must inform prospective team members of their policy prior to
the season.
Extra Help Sessions
Students may miss portions of practice time to attend academic extra help sessions or to make up
tests or quizzes. The Athletic Department must have a pass from the teacher to give to the coach.
Half Days
On half days the Student Center will be available to athletes waiting for practice. No team member may
leave campus unless prior authorization is granted (senior privilege). Notarized permission slips are
required. Students are encouraged to bring their own lunch. Food is available for purchase in the school
store. School personnel are not responsible for supervising student athletes who are waiting for practice.
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School Detention Detentions will be served on the date assigned regardless of the athletic schedule. It is our expectation
that athletes will follow all school rules and avoid the conflict of detention. School detentions are not an
excused absence from athletics.
Athletic Camps While the Athletic Department encourages our student athletes to improve their basic
skills by participation in summer camps, it must be understood that all such activities are
purely voluntary.
Parents and student athletes should be aware that participation in summer camp and
leagues does not in any way guarantee the player a position on any school team in the
years following her participation in the camp or league.
The School insurance policy, which covers student athletes during the school year, does
not cover injuries incurred during summer camps or leagues.
Cancellation and Postponement of Practices and Games The Director of Athletics will inform the main office and have the information posted on
highschoolsports.net of all cancellations and postponements as soon as possible.
Announcements will be made to students using the public address system when possible.
If school is dismissed early for weather reasons all games and practices are considered
canceled.
If snow causes the closing of school on a particular day, athletic events/practices may still
be held later in the day or evening. That decision will be made by Director of Athletics
in consultation with the Director of Facilities. Students/Parents will be notified by email
and phone chain.
Outdoor practices may be canceled due to inclement weather at the coach’s discretion. Student
athletes will be notified as soon as possible over the school’s public address system.
Parents and fans are encouraged to check www.highschoolsports.net for cancellation and
postponement updates.
Captains
Captains are an integral part of all athletic teams. The selection of team captains is the responsibility of
the coach. The coach may choose to select the team captains or allow the team to vote. All team
members will be considered regardless of grade level. The criteria includes: leadership abilities, team
dedication, a positive attitude and the ability to communicate with the coach and team. Team captains
must get along with peers and be available for their captain responsibilities.
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Expectations of a Team Captain:
Communicate with your coach to keep him/her informed about team issues
Be positive. Positive thinking is contagious.
Be disciplined on and off the field.
Work to develop team unity. Treat all team members with respect.
Changing for Practice/Games All athletes must change for practice in the locker room or the large bathroom in Saint Joe’s
adjacent to the School Store. Changing for practice in other areas of the school including
hallways, parking lots, or gymnasium foyer is prohibited.
Clubs and Activities Athletic practices will begin at 3:30 to accommodate club participation. Athletes need to be
dismissed at 3:15 to change before athletic practice. Two exceptions include Freshman
Basketball which will begin at 3pm due to the scheduling of practices in the gymnasium and JV
softball which requires transportation to an off-campus site.
Participation in school activities often creates considerable conflicts with athletics. It is
important for students to discuss possible conflicts with the activity moderators and the Director
of Athletics prior to committing to team participation. Students and parents should investigate
whether an activity is going to conflict with athletics prior to accepting membership on a team.
Communication A) Coaches
Each coach will have an email distribution list including parents and student athletes
so that all are aware of schedule changes and team related information.
It is strongly recommended that parents encourage their daughters to have open
communication with the coach. This generates growth and maturity and enables the
coach to speak directly to the student athlete to answer questions or concerns.
If a meeting between a coach and athlete does not solve the problem it is
recommended that the parents call or email the coach for an appointment. Catching
coaches following a contest is never appropriate.
B) Director of Athletics
If a meeting between the coach and parent proves to be unsatisfactory, the parent is asked to
contact the Director of Athletics at (908)757-0108 x4516 or [email protected]
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Selection to a team, captain or varsity status, awards, and playing time are decisions made by the
coaches. The Director of Athletics and the School Administration will not instruct the coaches
whom to play or keep on the team. Appropriate meeting topics include:
Concern about treatment of athletes, mentally or physically
Concerns of student athlete behavior
Lack of communication from coach.
Communication you should expect from the coach:
Expectations the coach has for a student athlete
Locations and times of practice sessions and contests, as well as practice cancellations
Team requirements
Prompt reply to phone or email messages
Concussion Policy Please see Appendix A
Dismissal From Team If a student quits a team or is put off a team she is not eligible to participate on another Varsity or Junior
Varsity team for a full year. Special considerations may be made for unique situations by the Athletic
Director, in consultation with the Directress.
Drug Testing / Use All athletes are subject to random drug testing for banned substances as outlined in the N.J.S.I.A.A.
steroid testing policy.
Performance Enhancing Drugs
It shall be considered a violation of the Sportsmanship Rule for any student-athlete to possess,
ingest, or otherwise use any of the substances on the list of banned substances, without a written
prescription by a fully-licensed physician, as recognized by the American Medical Association,
to treat a medical condition. Any person who tests positive in an NJSIAA-administered test, or any
person who refuses to provide a testing sample, or any person who reports his or her own violation,
will immediately forfeit his or her eligibility to participate in NJSIAA competition for a period of one
year from the date of the test. Any such person will also forfeit any individual honor earned while in
violation. No person who tests positive, refuses to provide a test sample, or who reports his or her
own violation will resume eligibility until he or she has undergone counseling and produced a
negative test result.
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The NJSIAA policy shall consist of this general prohibition, the NJSIAA Steroid Testing
Procedures, the NJSIAA Steroid Testing Protocol, and the NJSIAA Banned Drug Classes.
Any athlete found to be using performance enhancing drugs will be subject to discipline as
outlined in the Academy’s Student Handbook.
Alcohol / Tobacco In addition to the penalties stated in the student handbook, any student athlete that possesses or used
tobacco, alcohol or any other illegal drug may be suspended from participation in athletics as determined
by the Administration and Athletic Director. The student athlete will be required to attend practice and
games for the length of the suspension but will not be permitted to participate.
Eligibility Rule/NJSIAA
The NJSIAA has certain criteria for eligibility in interscholastic athletics. They are as follows:
Age – An athlete becomes ineligible for high school athletics if she attains the age of
nineteen prior to September 1 of any school year.
Credits, as outlined in the Academic Section on page 2
All athletes participating on a high school team must have an amateur status – an amateur
athlete is one who participates in athletes solely for the physical, mental, social, and
educational benefits derived from such participation. The amateur athlete treats all
athletic activities in which she participates as an avocational endeavor. One who takes or
has taken pay, or has accepted the promise of pay, in any form, for participation in
athletics or has directly or indirectly used her athletic skill for pay in any form shall not
be considered an amateur and will not be eligible for high school interscholastic athletics
in the State of New Jersey.
Semester of Eligibility – no student shall be eligible for high school athletics after the
expiration of eight consecutive semesters following her entrance into the 9th grade. A
student becomes ineligible for high school athletics when the class in which she was
originally enrolled has graduated.
Pre-High School Students – Students in any 6th
, 7th
, or 8th grades of any school who play
on 9th grade or so-called freshman or sophomore, junior varsity and varsity teams will be
ineligible at the conclusion of eight consecutive semesters of such participation. Please
notify the Athletic Director if you have played on a high school team prior to enrolling in
High School.
Academic Eligibility
Academic Policy - Team members must be eligible for competition according to N.J.S.I.A.A.
standards:
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a. To be eligible for athletic competition during the first semester of the 10th grade
of higher, a pupil must have passed 27.5 credits [30 beginning with the Class of
2014] during the immediately preceding academic year
b. To be eligible for athletic competition during the second semester of the 9th grade
or higher, a pupil must have passed 13.75 credits [15 beginning with the Class of
2014]
In addition, any student that has a failing grade on her report card or progress report will be put
on probation until a note from her teachers (stating that her work has improved) is given to the
athletic department.
Equipment / Uniforms The Mount collects a uniform bond at the beginning of the year/season of $200. Late
fees and lost item replacement will be deducted from the bond. The bond will be
returned less any fees at the end of the year.
All equipment and uniform items distributed by coaches is marked by name/number for
the purpose of maintaining accurate records. Any equipment or uniforms issued to
athletes will be recorded on an inventory distribution form to be used by coaches for
collection purposes at the conclusion of the season. All athletic equipment and uniforms
issued to athletes must be returned to the coach cleaned and promptly at the conclusion of
each season.
Athletes will be held accountable for any lost, stolen, or damaged equipment and must
pay the replacement charge for that item(s).
School-issued equipment should be secured at all times. Do not leave game gear in
unlocked lockers. Again, lost, stolen or damaged equipment is the responsibility of the
student athlete and he/she will be charged the replacement cost.
Issuing of equipment for out of season or summer use is prohibited unless specifically
approved by the Athletic Director. This may only occur in cases involving “special
expensive” equipment that athletes are not required to provide on their own (e.g. field
hockey goalie equipment). This equipment may be rented and used for attendance at a
camp.
Every coach will have two announced uniform return days. A fee of twenty dollars per
day will be deducted from the uniform bond for every school day that the uniform is not
returned beyond the collection days.
Uniform purchases are made on a rotating basis with each team getting new uniforms
approximately every five years.
The Mount does not purchase disposable items such as Under Armour, hats, socks, and
bathing suits which may be required for team participation.
Game Day Attire All athletes are expected to wear school issued/purchased or approved attire for games. This
includes the uniform, warm-ups, shooting shirts and bathing suits. Game day wear must be in
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school colors: royal blue, gold, and white. Optional apparel designed and purchased by team is
not considered game day attire
Team Apparel All purchases of apparel or any team items must be done through the Athletic Director. No student may
collect monies for the purpose of purchasing items. All purchases will be made by the Director of
Athletics. The school name may not be placed on any item without authorization.
Hazing “Hazing” refers to any activity expected of someone joining a group (or to maintain full status in
a group) that humiliates, degrades or risks emotional and/or physical harm, regardless of the
person's willingness to participate. Hazing is any intentional action taken, situation created, or
any conduct or method of initiation into any school organization, club, or team which denies a
person her individual rights or results in mental or physical discomfort, embarrassment,
harassment, ridicule, or endangerment.
The following are some examples of hazing divided into three categories: subtle, harassment,
and violent. It is impossible to list all possible hazing behaviors because many are context-
specific. While this is not an all-inclusive list, it provides some common examples of hazing
traditions.
A. SUBTLE HAZING:
Behaviors that emphasize a power imbalance between new members/rookies and other members
of the group or team. Termed “subtle hazing” because these types of hazing are often taken-for-
granted or accepted as “harmless” or meaningless. Subtle hazing typically involves activities or
attitudes that breach reasonable standards of mutual respect and place new members/rookies on
the receiving end of ridicule, embarrassment, and/or humiliation tactics. New members/rookies
often feel the need to endure subtle hazing to feel like part of the group or team. (Some types of
subtle hazing may also be considered harassment hazing).
Some Examples:
Deception
Deprivation of privileges granted to other members
Requiring new members/rookies to perform duties not assigned to other members
Socially isolating new members/rookies
Name calling
B. HARASSMENT HAZING: Behaviors that cause emotional anguish or physical discomfort
in order to feel like part of the group. Harassment hazing confuses, frustrates, and causes undue
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stress for new members/rookies. (Some types of harassment hazing can also be considered
violent hazing).
Some Examples:
Verbal abuse
Threats or implied threats
Asking new members to wear embarrassing or humiliating attire
Expecting new members/rookies to perform personal service to other members such as
carrying books
C. VIOLENT HAZING : Behaviors that have the potential to cause physical and/or emotional,
or psychological harm.
Some Examples:
Forced or coerced alcohol or other drug consumption
Beating, paddling, or other forms of assault
Forced or coerced ingestion of vile substances or concoctions
Public nudity
Abductions/kidnaps
Exposure to cold weather or extreme heat without appropriate protection
Hazing in any form will not be tolerated and may result in suspension or expulsion from
athletics, in addition to any penalties imposed in the Academy Student Handbook under
Discipline and the Harassment Mutual Respect Policy. Mount Saint Mary Academy will contact
the authorities for any and all unlawful acts.
Medical Issues / Injuries
Daily Reporting and Recording of Injuries It is the student athletes’ responsibility to report to the ATC and Coach all athletic injuries associated with
athletic participation immediately.
When an ATC learns of such an injury, she will notify the appropriate Coach or Coaches. Similarly when
a Coach learns of an injury he/she will notify the ATC. The ATC will make the necessary medical
referrals as indicated.
Injury Communication
It is the serious obligation of the athlete during her season to inform the athletic trainer if she has
seen, or has an appointment to see, a physician or other healthcare professional for an injury or
illness that will affect her ability to participate in athletics. To ensure consistency of injury care
between the Mount Saint Mary Academy athletic department and outside healthcare providers,
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any student-athlete who sees a physician or other healthcare provider for a condition which
does/may affect her participation in school sports must provide a note to our athletic trainer from
their healthcare provider indicating:
Injury/condition
Participation Status
Any additional recommendations, limitations, and/or specific instructions
Please make sure you give your doctor’s note directly to the athletic trainer. After you give your
note to the athletic trainer, she will provide you with a pass to give to your coach. The pass will
make your coach aware of your participation status. Notes are needed to excuse a student athlete
from practice/games and to return to participation.
It is very important that an injured student athlete follows up with the athletic trainer the day
following the injury and regularly as the injury progresses. The athletic trainer can facilitate
healing of the injury via rehabilitative techniques and modalities including electric stim,
ultrasound, therapeutic exercise, bracing and taping.
The athletic trainer and/or school nurse can require a student athlete to see a physician if they
feel an injury/illness warrants it.
1. Athletic Training
Certified athletic trainers, also known as ATCs, are medical professionals who specialize
in the prevention, assessment, treatment and rehabilitation of injuries and illnesses that
occur in athletes and the physically active.
As your child’s athletic trainer, I ensure that she remains healthy and is able to participate
in practices and games. My primary responsibilities are injury prevention, reduction of
further injury by administering immediate care, development and implementation of
rehabilitation programs and development of appropriate policies, including return-to-
play.
2. Concussion Policy – Please see Appendix A
Music
All music played for events in the gym or on Angels of Victory Field will be provided by
Academy personnel. Playlists will be compiled with input from all the team captains but will not
be team specific. No team may play a CD, ipod, or other device on the playing area or through
the audio system. This is for the enjoyment of all and to ensure appropriate content.
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Insurance
Mount Saint Mary Academy has a supplemental school-time accident insurance policy . The
policy is intended to provide supplemental accident medical insurance when accidental bodily
injury is sustained by a student while participating in a school sponsored activity. The school
insurance is supplemental and as such is excess to the primary insurance policy of the family.
The purpose of the secondary insurance is to assist families with the out of pocket expenses often
associated with accidental injuries, only after the claim has been processed through the families’
primary insurance.
Parents/students must notify the person responsible for the school activity immediately when an
accident has occurred. Supplemental insurance forms can be obtained through the schools
administrative offices. Claims will only be considered if made with 90 days of the incident.
Physical Education Exemption
Physical Education is important to the educational experience at the Mount. We require all
Freshmen and Sophomores to take Physical Education. Juniors and Seniors participating in
Mount Athletics may choose to take a study in the library during P.E. class only after the
appropriate forms are completed with the Physical Education department. Any student enrolled
in P.E. that does not participate due to a medical note is ineligible to participate in athletics.
Pick up post games and practices
Coaches are required to wait a reasonable amount of time (15 minutes) for athletes to be picked
up at the end of practices or games. For the safety of the students, all athletes not picked up will
be asked to wait in the study center in the Main Building. Students waiting for late practices
should also wait in the study center. On half days students will have lunch and wait in the
student center in Saint Joe’s. The school staff is not responsible for supervising athletes waiting
for rides.
Pictures Team and individual pictures will be taken throughout the season for the purpose of publicity.
Schedule
Mount Saint Mary Athletic schedules can be found at www.highschoolsports.net
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Sportsmanship
At Mount Saint Mary Academy it is an expectation that our coaches, players, and fans will
exhibit good sportsmanship at all times. Athletics provides us with the opportunity to show the
best of ourselves in difficult situations. At the Mount we want to “honor the game” and learn to
compete hard but with grace and humility. Our expectation is we will compete fiercely to win
but in the end we want to win the game, fairly as it is supposed to be played.
In honoring the game we show respect for all of its aspects – Opponents, Officials, Coaches,
Teammates and Ourselves.
Opponents – show opponents the respect they deserve. Help them up after a
collision. Always shake hands and congratulate them on a well played game win
or lose.
Officials – Accept the decisions of officials without incident. Players should
never question officials.
Coaches – Always show respect for your coaches. If you have a question or
concern, email the coach for a meeting.
Teammates – Never criticize, demean, or embarrass your teammates on or off the
playing area.
The Game – Play fairly – accept with dignity, the outcome of a contest.
Mount Saint Mary Academy takes sportsmanship very seriously. As with all aspects of the
school, the Core Values of Respect, Integrity, Compassion, Justice, and Service are the
cornerstone of the program.
Unsportsmanlike conduct will not be tolerated and will subject the individual to disciplinary
action
Unsportsmanlike conduct shall include but not be limited to the following:
Any athlete who uses obscene gestures or profane or unduly provocative language or
action towards officials, opponents, or spectators.
Any athlete who intentionally incites participants or spectators to violent or abusive
action
Any athlete who strikes or physically abuses an official, opposing coach, player, or
spectator
In addition to the NJSIAA disciplinary action, any violations of our sportsmanship
rule, including, but not limited to disqualifications in the area of racial, ethnic, gender
bias, will result in the NJSIAA contacting and working directly with the Conference
and Community Agency (Human Rights/Civil Rights Group) which focuses in on this
important aspect of social behavior as it relates to athletics.
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Any Student-Athlete or coach disqualified before, during or after an interscholastic event for
unsportsmanlike and flagrant verbal or physical misconduct will be disqualified from the next
two (2) regularly scheduled games/meets. Mount Saint Mary Academy Administration may add
to this suspension period or impose disciplinary action as deemed appropriate.
Once a coach/player has been disqualified, NO appeals to the NJSIAA will be honored from the
player, coach, official, or any other party.
A disqualified player or coach may not be present at any contest in that sport during the period of
disqualification. Definition of not being present at the site means the disqualified player or
coach is not to be present in the locker room, on the bus, on the sidelines, in the stands or site
area before, during or after the game/meet.
Spectator Code
The school community is strongly encouraged to attend and support Mount athletic events. To
ensure a positive experience for all, we require all spectators to adhere to the following set of
standards:
Conform to all rules set forth by Mount Saint Mary Academy, the Skyland Conference,
the Somerset County Athletic Association, the NJSIAA, and the NJISAA.
Always demonstrate good sportsmanship
Refrain from use of profanity or obscenities
Accept the decisions of officials
Be considerate of injured players of both teams
Cheer for your team and not against opponents
Support your coaches and all members of the team
Refrain from criticizing or demeaning all athletes, coaches, officials, or fans
Respect the contest
Transfers
A student athlete transferring from one secondary school to another, without a bona fide change
of residence by that student’s parent or guardian, shall be ineligible to participate for a period of
thirty (30) calendar days or one half of the maximum number of games allowed in the sport by
NJSIAA rules (the ineligibility period) from the beginning of the regular schedule, whichever is
less, in any sport in which the student has previously participated at the varsity level.
To prevent possible recruitment or transfer for athletic advantage, a Transfer Form must be
executed by the two involved schools and filed with the NJSIAA before any interscholastic
participation.
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A student who transfers during the second half of a sports season, regardless of whether the
transfer was the result of a bona fide change of residence, shall be ineligible to participate in any
post-season championship competition at the new school.
Transportation
The Mount will provide transportation to and from athletic contests and off campus practice sites
when school is in session. However, transportation may not be provided for weekend events.
Any student who utilizes Mount transportation to an event but is not returning to the
Mount on the bus must have a parent/guardian’s signature. Parents/guardian must fill out
the appropriate form with the coach prior to leaving any off-campus site with the student
athlete. The Mount will not provide transportation for any student athlete that does not
adhere to this policy. Any student who leaves any athletic contest/practice without
following the proper procedure is subject to disciplinary action that may include
suspension from the team.
Mount Saint Mary Academy is not responsible for students who leave
practice/competition with anyone other than those designated by the parent/guardian.
The Athletic Department and members of the coaching staff strongly encourage the use
of Mount transportation to and from events when provided for safety reasons as well as
team chemistry and camaraderie.
Students may drive to away games only in emergency circumstances. However, the
student must have a note from a parent/guardian approved by the Director of Athletics.
Athletes must make their teachers aware of all early dismissals and make up any work
missed.
Students may drive to offsite practice sites as long as the student has a note granting
permission from a parent/guardian on file in the athletic office.
Tryouts
In order to be eligible to try out for a team, all students must have a completed physical form, a health
update form (Winter & Spring), an emergency consent form, a steroid testing/concussion policy
form, a uniform bond form and a Mount athletic team policies form.
It is the responsibility of the coach through the tryout process, to form the most competitive team
regardless of previous participation. Each student must try-out every year. Teams are selected on the
basis of current performance, not past participation. Students are evaluated by ability not by seniority.
The athletic department endeavors to have a place for everyone to experience competition. However on
occasion we are forced to limit the size of teams.
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Dates for tryouts:
Fall Sports – August 20, 2012
Winter Sports – November 26, 2012
Spring Sports – March 4, 2013
Valuables/Security Student athletes are responsible for securing all valuables during practices and games. Please
make sure your things are locked in a locker and not left out in the locker room or foyer of the
gymnasium. Be cautious about bringing valuables to away contests where lockers will not be
available.
Varsity Letters and Awards The athletic department recognizes all of its athletes at the Athletic Awards night held at the Pines Manor
in May.
The awarding of varsity letters is at the discretion of the Head Coach. Players must be in attendance for
¾ of the game schedule or length of the season to be considered for a Varsity letter. This includes those
who are injured or ill.
Participation in varsity contests is a determining factor for athletes participating on a team sport.
In the area of individual sports specifically Cross Country and Winter/ Spring Track, the varsity and JV
line is not as clearly defined due to the nature of participation.
Cross Country and Track letters will be awarded as follows:
Cross Country – varsity letters are given to any athlete in three ways
Receives a varsity medal in any competition
Competes in the NJSIAA Group Championship or is an alternate
Runs a 5k time faster than the 8th fastest time of the previous year. For the 2012 cross country
season the time would be 21:59.
Winter Track- if the athlete achieves any of the following, they can receive a varsity letter
Receives a varsity medal in any competition
Scores as an individual or as part of a relay at any Championship meet
Scores 20 or more points in dual meets
Runs a time in an event faster than the second fastest Mount runner did in the previous
year.
Qualify for the Winter Meet of Champions or the Outdoor Group Championships
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Spring Track – if the athlete achieves any of the following, they receive a varsity letter
Qualify for the Spring Track Meet of Champions or the Outdoor Group Championships
Time qualifications
Running Events-
o 400m IH - 80, 100m - 14.3, 1600m - 5:45, 400m - 66, 100m HH - 18, 800m -
2:31, 200 - 28, 3200m - 12:20
Field Events
o HJ - 4' 4", LJ - 14', TJ - 31', PV - 8', SP - 23', Jav - 70', Dis - 75'
Letter Winners – Varsity
First year – letter
Second year – Pin
Third year – Pin
Fourth year – Gold letter
Most Valuable Player
The Most Valuable Player is an award given to the best performing player on the team as
determined by the coaching staff. This award can be given to any player on the varsity roster. In
the event the coaches feel that two players are tied, two awards will be given.
Coach’s Award
The Coach’s Award is given to the player who demonstrates the most leadership, sportsmanship,
and team spirit. She exemplifies what it means to be a Mount Athlete representing our
philosophy and ideals.
The Coach’s Award is given on each varsity team and is selected by the coaching staff.
Athlete of the Year
This award is given to a senior athlete that has shown exceptional athletic ability throughout her
four years at the Mount. This award is not given every year but only in those instances when we
have a truly deserving athlete.
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Scholar Athlete
This award will be given to a senior student or several students to represent the Mount for the
NJSIAA, Skyland Conference, and Independent Schools.
The award takes into consideration academic and athletic performance.
Must be in the first or second quintile of the class
GPA no less than 3.0
Participated on a varsity sport for at least two years
Have shown outstanding school and community citizenship
Selection will begin with academics. When academic ability among students is close,
athletic participation and abilities will be the deciding factor.
Voting process for both Athlete of the Year and Scholar Athlete
Athletes can apply or be nominated by their coach.
Coaches submit a recommendation on all athletes nominated from their sport.
A committee of faculty/coaches will review all applications.
Each committee member gets one vote.
Weight Room The weight training room is located in the back room of the Athletic Training room in Gabriel
Hall.
The fitness room includes five pieces of strength training that feature new technology utilizing
pneumatic, or air powered, machines creating resistance training through air pressure.
The machines themselves are sleek and lightweight in design and provide resistance that begins
at zero and goes up in one pound increments at the touch of a button. The pressurized air will
provide resistance greater than we will ever need with some pieces having the capability of over
300 pounds.
The equipment is very user friendly and nonthreatening – the lack of weight stacks provide a
private workout and removes competitiveness.
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The machines we have selected will cover the major muscle groups of the body. They include
the leg extension, leg press, upper back, and chest press. We have also purchased a Functional
Trainer which is a Cable Machine that is also pneumatic in design but can offer the user a total
body workout of hundreds of exercises. Student athletes can also do sport-specific exercises
utilizing the Functional Trainer.
In addition to the strength training equipment we have an elliptical and a treadmill for
cardiovascular workouts.
Students / Athletes are required to have a permission slip to use the weight room.
APPENDIX A
Concussion Policy Mount Saint Mary Academy’s Concussion Protocol for the Prevention and Treatment of
Sports Related Concussions and Head Injuries
Prevention
1. It is recommended that all student athletes obtain a computer based pre-season
baseline test such as ImPACT or Headminder at an approved facility. The school
Licensed Athletic Trainer can advise regarding facilities.
2. Review of educational information for student athletes on prevention of concussions.
3. Reinforcement of the importance of early identification and treatment of concussions
to improve recovery.
- Student athletes who are exhibiting the signs and symptoms of a sports related
concussion or other head injuries during practice or competition shall be
immediately removed from play and may not return to play that day
Education
All student athletes who participate in interscholastic sports receive the NJDOE
Concussion and Head Injury fact sheet / NJSIAA Concussion Policy Acknowledgement
Form.
Possible Signs of Concussion:
(Could be observed by Coaches, Licensed Athletic Trainer, School Nurse)
1. Appears dazed, stunned, or disoriented.
2. Forgets plays, or demonstrates short term memory difficulty.
3. Exhibits difficulties with balance or coordination.
4. Answers questions slowly or inaccurately.
5. Loses consciousness.
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Possible Symptoms of Concussion:
(Reported by the student athlete to Coaches, Licensed Athletic Trainer, School Nurse,
Parent/Guardian)
1. Headache
2. Nausea/Vomiting
3. Balance problems or dizziness
4. Double vision or changes in vision
5. Sensitivity to light or sound/noise
6. Feeling sluggish or foggy
7. Difficulty with concentration and short term memory
8. Sleep disturbance
9. Irritability
Student athletes must be evaluated by a physician or licensed health care provider
trained in the evaluation and management of concussion to determine the presence or
absence of a sports related concussion or head injuries.
To return to practice and competition the student athlete must follow the protocol:
1. Immediate removal from competition or practice. 911 should be called if
there is a deterioration of symptoms, loss of consciousness, or direct neck pain
associated with the injury.
2. When available the student athlete should be evaluated by the school’s
licensed healthcare provider who is trained in the evaluation and management
of concussions.
3. School personnel (Athletic Director, Licensed Athletic Trainer, School Nurse,
Coach, etc.) should make contact with the student athlete’s parent/guardian
and inform him/her of the suspected sports related concussion or head injury.
4. School personnel (Athletic Director, Licensed Athletic Trainer, School Nurse,
Coach, etc.) shall provide the student athlete with Mount Saint Mary
Academy’s suggestions for management/medical checklist to provide their
parent/guardian and physician or other licensed healthcare professional trained
in the evaluation and management of sports related concussions and other
head injuries.
5. The student athlete must receive written clearance from a physician
trained in the evaluation and management of concussions that states the
student athlete is asymptomatic at rest and may begin the graduated
return to play protocol.
Graduated Return to Competition and Practice Protocol
- Complete physical, cognitive, emotional, and social rest is advised while the student
athlete is experiencing symptoms and signs of a sports related concussion or other head
injury. (Minimize mental exertion, limiting overstimulation, multi-tasking, etc.)
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- After written medical clearance is given by a physician trained in the evaluation and
management of concussions stating that the student athlete is asymptomatic at rest,
the student athlete may begin a graduated individualized return to play protocol
supervised by Licensed Athletic Trainer, or in cases where the aforementioned is
not available, a physician or licensed healthcare provider trained in the evaluation
and management or sports related concussions. The following steps should be
followed:
1. Completion of a full day of normal cognitive activities (school day, studying for tests,
watching practice, interacting with peers) without re-emergence of any signs and
symptoms. If no return of symptoms, next day advance to:
2. Light aerobic exercise, which includes walking, swimming, or stationary cycling,
keeping the intensity <70% maximum percentage heart rate: no resistance training.
The objective of this step is increased heart rate. If no return of symptoms, next day
advance to:
3. Sport specific exercise including skating, and/or running; no head impact activities.
The objective of this step is to add movement and continue to increase heart rate. If
no return of symptoms, next day advance to:
4. Non-contact training drills (e.g. passing drills). The student athlete may initiate
progressive resistance training. If no return of symptoms, next day advance to:
5. Following medical clearance (consultation between school health care personnel, i.e.
Licensed Athletic Trainer, School Nurse, and student athlete’s physician),
participation in normal training/practice activities. The objective of this step is to
restore confidence and to assess functional skills by the coaching staff. If no return of
symptoms, next day advance to:
6. Return to play involving normal game exertion or game activity.
If the student athlete exhibits a re-emergence of any concussion signs or symptoms
once they return to physical activity, she will be removed from further exertional
activities and returned to her primary care physician.
If concussion symptoms reoccur during the graduated return to play protocol, the
student athlete will return to the previous level of activity that caused no symptoms.
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Athletic Policies Acknowledgement Form
Dear Parents,
This year we have developed an Athletic Handbook. The Athletic Handbook can be
found on the Mount website’s Athletic Page. Please review it carefully with your daughter. We
hope that you find the Handbook helpful and informative. Fall athletes: please return this form
with the athletic forms on August 20, 2012. Winter and Spring participants may return the set of
forms along with other mandatory forms for the school. The completed package can either be
dropped off at the Main reception desk in a sealed envelope to the attention of Mrs. Shaw, or can
be sent by Federal Express to the school prior to August 31, 2012.
Sincerely,
Denise E. Materia
Director of Athletics
---------------------------------------------------------------------------------------------------------------------
PLEASE RETURN TO THE ATHLETIC OFFICE
We have read the school Athletic Handbook posted on the Mount Saint Mary Academy’s
website and understand the rules and regulations. In signing this form, we agree to follow the
rules as set forth in the handbook.
____________________________________ ______________________________
Parent Signature Date Student Signature Date
____________________________________ ______________________________
Print Name Print Name
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Mount Saint Mary Academy Athletic Uniform Bond
The Mount Saint Mary Academy Athletic department will collect a
$200.00 athletic uniform bond from all athletes.
All bonds will be returned at the conclusion of the school year. Any athlete that does not return the uniform, complete and in good
condition, to her coach, on one of the two designated return dates
will result in a $20.00 per day fine not to exceed $200.00.
All checks are to be made payable to Mount Saint Mary Academy.
All checks will be cashed upon receipt.
Students Name: ________________________________________
Sport(s): ______________________________________________
I have read the above statement, and understand that failure to return the
uniform to the coach within a week of the close of the season and on
one of the two designated return dates, will result in a $20.00 per
day fine until the uniform is handed in or the fines exceed $200.00.
____________________________ _________________________
Parent or Guardian Signature Student Signature
Date:_______________________ Check #:__________________
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MSMA Emergency Information and Consent Form 2012-2013
STUDENT NAME ________________________________________________ Graduation Year _____________________
DATE OF BIRTH ___________________________ STUDENT PHONE: ______________________________________
In case of EMERGENCY, ILLNESS OR ACCIDENT please provide names and telephone numbers of person(s) who may be contacted
immediately.
FATHER/GUARDIAN_____________________________________________________________________________________________
ADDRESS________________________________________________________________________________________________________
HOME PHONE(_______)________ -__________ WORK#(_______)________-___________EXT._________HOURS________________
E-Mail ADDRESS_______________________________________________________ CELL PHONE #_____________________________
MOTHER/GUARDIAN____________________________________________________________________________________________
ADDRESS________________________________________________________________________________________________________
HOME PHONE(_______)________ -__________ WORK#(_______)________-___________EXT._________HOURS________________
E-Mail ADDRESS_______________________________________________________ CELL PHONE #_____________________________
RELATIVE/FRIEND______________________________________________________________________________________________
ADDRESS________________________________________________________________________________________________________
HOME PHONE(_______)________ -__________ WORK#(_______)________-___________EXT.__________HOURS_______________
PHYSICIAN___________________________________________________ PHONE#(________)_________-____________
ADDRESS_______________________________________________________________________________________________________
PREFERRED
HOSPITAL__________________________________________________________________________________________________
IN THE EVENT OF AN EMERGENCY, MOUNT SAINT MARY ACADEMY’S STAFF WILL MAKE EVERY EFFORT TO HAVE YOUR
DAUGHTER TRANSPORTED TO YOUR PREFERRED HOSPITAL. UNFORTUNATELY, THERE ARE CIRCUMSTANCES WHEN A
RESPONDING FIRST AID SQUAD MUST TRANSFER YOUR DAUGHTER TO THE NEAREST HOSPITAL. YOUR SIGNATURE WILL
ALLOW FOR THE TREATMENT OF YOUR DAUGHTER AT EITHER THE PREFERRED OR NEAREST HOSPITAL.
PERMISSION GRANTED FOR TREATMENT AT PREFERRED OR NEAREST HOSPITAL
PARENT / GUARDIAN SIGNATURE DATE
NOTARY SIGNATURE AND SEAL DATE
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NJSIAA STEROID TESTING POLICY AND
PARENT/GUARDIAN CONCUSSION POLICY
ACKNOWLEDGMENT FORMS
NJSIAA STEROID TESTING POLICY
CONSENT TO RANDOM TESTING
In Executive Order 72, issued December 20, 2005, Governor Richard
Codey directed the New Jersey Department of Education to work in
conjunction with the New Jersey State Interscholastic Athletic Association
(NJSIAA) to develop and implement a program of random testing for
steroids, of teams and individuals qualifying for championship games.
Beginning in the Fall, 2006 sports season, any student-athlete who
possesses, distributes, ingests or otherwise uses any of the banned
substances on the attached page, without written prescription by a fully-
licensed physician, as recognized by the American Medical Association, to
treat a medical condition, violates the NJSIAA’s sportsmanship rule, and is
subject to NJSIAA penalties, including ineligibility from competition. The
NJSIAA will test certain randomly selected individuals and teams that
qualify for a state championship tournament or state championship
competition for banned substances. The results of all tests shall be
considered confidential and shall only be disclosed to the student, his or
her parents and his or her school. No student may participate in NJSIAA
competition unless the student and the student’s parent/guardian consent
to random testing.
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NJSIAA Banned-Drug Classes
2010 - 2011 The term “related compounds” comprises substances that are included in the class by their pharmacological action and/or chemical structure. No substance belonging to the prohibited class may be used, regardless of whether it is specifically listed as an example. Many nutritional/dietary supplements contain NJSIAA banned substances. In addition, the U. S. Food and Drug Administration (FDA) does not strictly regulate the supplement industry; therefore purity and safety of nutritional dietary supplements cannot be guaranteed. Impure supplements may lead to a positive NJSIAA drug test. The use of supplements is at the student-athlete’s own risk. Student-athletes should contact their physician or athletic trainer for further information. The following is a list of banned-drug classes, with examples of banned substances under each class: (a) Stimulants (b) Anabolic Agents (c) Diuretics (d) Peptide Hormones & Analogues: amiphenazole anabolic steroids acetazolamide corticotrophin (ACTH) amphetamine androstenediol bendroflumethiazide human chorionic gonadotrophin (hCG) bemigride androstenedione benzhiazide leutenizing hormone (LH) benzphetamine boldenone bumetanide growth hormone (HGH, somatotrophin) bromantan clostebol chlorothiazide insulin like growth hormone (IGF-1) caffine1 (guorana) dehydrochlormethyl- chlorthalidone chlorphentermine testosterone ethacrynic acid All the respective releasing factors cocaine dehydroepiandro- flumethiazide of the above-mentioned substances cropropamide sterone (DHEA) furosemide also are banned: crothetamide dihydrotestosterone (DHT) hydrochlorothiazide erythropoietin (EPO) diethylpropion dromostanolone hydroflumenthiazide darbypoetin dimethylamphetamine epitrenbolone methyclothiazide sermorelin doxapram fluoxymesterone metolazone ephedrine gestrinone polythiazide (ephedra, ma huang) mesterolone quinethazone ethamivan methandienone spironolactone ethylamphetamine methenolone triamterene fencamfamine trichlormethiazide meclofenoxate and related compounds methamphetamine methyltestosterone methylenedioxymethamphetamine nandrolone (MDMA, ecstasy) norandrostenediol methylphenidate norandrostenedione nikethamide norethandrolone pemoline oxandrolone pentetrazol oxymesterone phendimetrazine oxymetholone phenmetrazine pregnelone phentermine stanozolol phenylpropanolamine (ppa) testosterone2 picrotoxine tetrahydrogestrinone pipradol (THG) prolintane trenbolone strychnine and related compounds synephrine other anabolic agents (citrus aurantium, zhi shi, clenbuterol bitter orange) and related compounds (e) Definitions of positive depends on the following: 1 for caffine – if the concentration in urine exceeds 15 micrograms/ml
2 for testosterone – if administration of testosterone or use of any other manipulation has the result of increasing the ratio of the total
concentration of testosterone to that of epitestosterone in the urine of greater than 6:1, unless there is evidence that this ratio is due to a
physiological or pathological condition.
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NJSIAA PARENT/GUARDIAN
CONCUSSION POLICY ACKNOWLEDGMENT FORM
In order to help protect the student athletes of New Jersey, the NJSIAA has mandated that all
athletes, parents/guardians and coaches follow the NJSIAA Concussion Policy.
A concussion is a brain injury and all brain injuries are serious. They may be caused by a
bump, blow, or jolt to the head, or by a blow to another part of the body with the force
transmitted to the head. They can range from mild to severe and can disrupt the way the brain
normally works. Even though most concussions are mild, all concussions are potentially
serious and may result in complications including prolonged brain damage and death if
not recognized and managed properly. In other words, even a “ding” or bump on the head
could be serious. You can’t see a concussion and most sports concussions occur without loss
of consciousness. Signs and symptoms of concussion may show up right after the injury or can
take hours or days to fully appear. If your child/player reports any symptoms of concussion, or if
you notice the symptoms or signs of concussion yourself, seek medical attention right away.
Symptoms may include one or more of the following:
1. Headache 2. Nausea/vomiting 3. Balance problems or dizziness 4. Double vision or changes in vision 5. Sensitivity to light or sound/noise 6. Feeling of sluggishness or fogginess 7. Difficulty with concentration, short-term memory, and/or confusion 8. Irritability or agitation 9. Depression or anxiety 10. Sleep Disturbance
Signs observed by teammates, parents and coaches include:
1. Appears dazed, stunned, or disoriented 2. Forgets plays or demonstrates short-term memory difficulties (e.g. is unsure of
the game, score, or opponent) 3. Exhibits difficulties with balance or coordination 4. Answers questions slowly or inaccurately 5. Loses consciousness 6. Demonstrates behavior or personality changes 7. Is unable to recall events prior to or after the hit
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What can happen if my child/player keeps on playing with a concussion or returns too
soon?
Athletes with the signs and symptoms of concussion should be removed from play immediately.
Continuing to play with the signs and symptoms of a concussion leaves the young athlete
especially vulnerable to greater injury. There is an increased risk of significant damage from a
concussion for a period of time after that concussion occurs, particularly if the athlete suffers
another concussion before completely recovering from the first one. This can lead to prolonged
recovery, or even to severe brain swelling (second impact syndrome) with devastating and even
fatal consequences. It is well known that adolescent or teenage athletes will often under report
symptoms of injuries. And concussions are no different. As a result, education of
administrators, coaches, parents and students is the key for student-athletes’ safety.
If you think your child/player has suffered a concussion
Any athlete even suspected of suffering a concussion should be removed from the game or
practice immediately. No athlete may return to activity after an apparent head injury or
concussion, regardless of how mild it seems or how quickly symptoms clear. Close observation
of the athlete should continue for several hours.
An athlete who is suspected of sustaining a concussion or head injury in a practice or game
shall be removed from competition at that time and may not return to play until the athlete
receives written clearance from a physician trained in the evaluation and management of
concussions that states the student athlete is asymptomatic at rest and may begin the
graduated return to play protocol. The graduated return to play protocol is a series of six steps,
the first being a completion of a full day of normal cognitive activities without re-emergence of
symptoms.
Day 2: light aerobic exercise, keeping the student’s heart rate <70% max
Day 3: sport specific exercises: running, etc. No head impact activities.
Day 4: non-contact training drills such as passing, shooting. Some progressive resistance
training.
Day 5: normal training/practice activities, following medical clearance.
Day 6: return to play involving normal game exertion or game activity.
You should also inform your child’s Coach, Athletic Trainer (ATC), and/or Athletic Director, if you
think that your child/player may have a concussion. And when in doubt, the athlete sits out.
For current and up-to-date information on concussions you can go to:
http://www.cdc.gov/ConcussionInYouthSports
http://www.nfhslearn.com
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NJSIAA STEROID TESTING POLICY
CONSENT TO RANDOM TESTING
By signing below, we consent to random testing in accordance with the NJSIAA
steroid testing policy. We understand that, if the student or the student’s team qualifies
for a state championship tournament or state championship competition, the student
may be subject to testing for banned substances.
___________________ ___________________ ____________
___________________ ___________________ ____________
NJSIAA PARENT/GUARDIAN
CONCUSSION POLICY ACKNOWLEDGMENT FORM
By signing below, we agree to abide by the NJSIAA Concussion Policy. We have read
and understand the risks associated with continuing to play with the signs and
symptoms of a concussion.
___________________ ___________________ ____________
___________________ ___________________ ____________
Signature of Student-Athlete Print Student-Athlete’s Name
Signature of Parent/Guardian Print Parent/Guardian’s Name
Date
Date
Signature of Student-Athlete Print Student-Athlete’s Name
Signature of Parent/Guardian Print Parent/Guardian’s Name
Date
Date
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MOUNT SAINT MARY ACADEMY WEIGHT ROOM PERMISSION FORM
My daughter _____________________________ has my permission to participate in using the
weight room facilities under the supervision of Mount Saint Mary Academy staff after regular school
hours. In an emergency and I can’t be reached, I grant permission for emergency medical treatment
to be given to my child.
1. I understand and accept that participants using the weight room equipment can suffer serious
injury or death.
2. I understand that a trained staff supervisor must be present; that students must adhere to all safety
precautions and school rules; and that this permission slip must be on file in the weight room office
prior to participation.
3. Hold-Harmless Agreement: I agree to indemnify and hold harmless the Mount Saint Mary
Academy Administration, Board of Trustees, employees, and volunteers while acting within the
scope of their duties as such, from and against all claims, demands, losses, and liabilities of any kind
and character, including costs of defense, arising out of or in any way connected with the registrant’s
participation in this activity.
I further agree to adhere to all rules and regulations posted in the weight room. I understand that if I
do not follow all the rules associated allowing my participation in the weight room, my privilege of
use will be terminated.
Student’s Name:_____________________________
_________________________________________________________________________ Student’s Signature DATE
_________________________________________________________________________
PARENT/GUARDIAN SIGNATURE DATE
_________________________________________________________________________
NOTARY SIGNATURE AND SEAL DATE
Emergency Contacts
1. Name:____________________________ Cell Phone:__________________________
2. Name:____________________________ Cell Phone:__________________________
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School Athletic Physical
The School Athletic Physical must also be returned for
participation in Athletics. For Fall sports, the physical
must be completed after July 6, 2012. The Physical form
can be found in the “Forms” section online.
