Student Athlete Physical Packet

Edgewood ISD Athletic Participation Form

  • Dear Student/ Parent/Guardian,

     

    It is that time of year to start preparing for the upcoming 2014-2015 athletic season.  Edgewood ISD is offering students the opportunity to get a free sport physical again this year.  All students who are entering their first or third year of participation in athletics will be required to get a sport physical.  However, ALL students, including those in their second and fourth years of participation are required to review and acknowledge with signatures all of the UIL forms, EISD forms, and asthma forms (if student has asthma) on a yearly basis. With the exception of the medical history form and physical examination form, all forms must be completed online under www.eisd.net under the Athletics tab and under either the middle school or high school tabs. If you don’t have access to a computer, you are more than welcome to set up a time with us to complete it online. Please update your information online as information changes (phone, address, contact information, etc.).  This means that all students are required to complete all forms in order to be eligible for sports in 2014-15.

     

    The sports physicals for Memorial High School are scheduled for Wednesday, April 16, 2014 from 3:15pm-5:30pm @ Memorial HS Athletic Training room.  Kennedy High School boys and girls will be Tuesday, April 8th, 2014 from 7:30am-9:30am @ JFK gym. Wrenn Middle School will be from 4pm-6:30pm @ Wrenn gym on Tuesday, April 8th, 2014. Brentwood Middle School will be from 4pm-6:30pm on Thursday, April 10th, 2014 @ Brentwood gym. Gus Garcia Middle School will be on Tuesday, April 29th, 2014 from 4pm-6:30pm @ Gus gym. Any student wishing to participate in athletic events will be eligible to obtain a free physical at this time.  Any student who needs a physical in order to participate in school sports that does NOT attend these physical dates will have to go on their own to a qualified professional (chiropractor, nurse practitioner, or medical doctor) to get a physical. Forms will be distributed to all athletes beginning on April 1, 2014.  Any student who doesn’t have athletics and is interested can pick up a physical form from their athletic trainer.  Students who intend to receive a free physical will be required to fill out paperwork and turn it into their head coach at least one day before the scheduled physical date.

     

    NOTE: It is IMPERATIVE that all forms are filled out entirely, signed by the student and parent BEFORE a physical can be administered.  The student will not be able to proceed to the physical unless filled out correctly.  On the day of the physicals, there will be a check in station and staff members will review the forms.  The doctors will not be able to give a physical to any student, unless the forms are properly completed.  Also, please see flyer for instructions on what to wear for the physical.  If you have any questions, please don’t hesitate to contact us.  Thank you for your cooperation and support.

     

    NOTE to PARENTS/GUARDIANS:

    The parent/guardians are to complete the Athletic Physical Packet online.

    Please have the following information readily available to input:

    ·        STUDENT’S SCHOOL ID NUMBER

    ·        INSURANCE INFORMATION/MEDICAL COVERAGE INFORMATION

    • Government Assistance Program Name ( i.e., CHIPS, Medicaid, etc .including  ID/Policy Numbers
    • Name of Insurance, Policy Number, and Name of Policy Holder
    • Last four digits of Parent/Guardian and Student's SS# to be used in place of signature

     

    Also, if your child answers: “yes” to the question: Does your child have asthma?

    PARENTS/GUARDIANS are responsible for requesting the ASTHMA MEDICINE PLAN and submitting the form to the assigned campus District Athletic Trainer.

     

    Sincerely,

     

    Latissa Eisenberg                              Monica Garza                                   Alex Juarez

    Kennedy High School Athletic Trainer                   Memorial High School Athletic Trainer                 EISD Athletic Trainer

    1922 S. Gen. McMullen, SAT 78226                      1227 Memorial Street, SAT 78228                        4133 Eldridge Avenue, SAT 78237

    Office: 210-444-8028                                              Office: 210-444-8345                                             Office:210-444-7990

    Email: latissa.eisenberg@eisd.net                           Email: monica.garza@eisd.net                               Email: alex.juarez@eisd.net

     

Student Information (Please enter ALL CAPS)

Parent/Guardian 1 Information

Parent/Guardian 2 Information

Emergency Contact Info

Insurance Information

EISD Non-Prescription Medication Permission Form

MEDICAL HISTORY INFORMATION

EISD MEDICATION PROTOCOLS

  • ·        Students, Parents, and/or Guardians acknowledge, understand, and agree if a student who participates in athletics is diagnosed with an illness warranting medication, an injury, a medical procedure (dental inclusive), and/or has side effects from said illness,injury or medical procedure (dental inclusive), after the Pre-Participation Physical Evaluation, that student and/or parent/guardian is to notify the Nurse and the Coach within 3 days of diagnosis. That student must provide supporting documentation from the physician's office.

    ·        Students, Parents, and/or Guardians acknowledge, understand, and agree that Coaches will not accept medications from a parent/guardian. Coaches will direct parents/guardians to give any medication directly to the school nurse. The school nurse will verify the medication information, log in the medication information, deliver the medication to the coach,and provide training on recognition of signs and symptoms, medication administration, and documentation. The Coach’s receipt of medication will be documented.

    ·        Students, Parents, and/or Guardians acknowledge, understand, and agree that the coach will keep all student medications stored securely in an easily accessible location. Under no circumstances should a student be allowed access to unsupervised medications. Students who have submitted the required paperwork from their parents/guardians and physician and who have been cleared by the school nurse may self-carry and administer their prescription asthma inhaler, Epi-pen, and/or diabetes testing supplies and medication. The school nurse will inform the coaches about students who meet these requirements.

    ·        Students, Parents, and/or Guardians acknowledge, understand, and agree that a student, authorized to carry their prescription medication, are responsible for bringing asthma or anaphylaxis medication on field trips, local and out of town games. Each Coach must ensure those students that carry asthma or anaphylaxis medications have them prior to participating in any event. If a student fails to bring their asthma or anaphylaxis medication, that student may not participate in the event, whether local or out of town, unless a parent/guardian brings the asthma or anaphylaxis medication. If a student fails to bring said medication, and there is an out of town game/event, that student may not ride on the bus for said game/event with teammates. That student must be sent home unless the parent/guardian can bring their asthma or anaphylaxis medication prior to departure time.

    ·       Students, Parents, and/or Guardians acknowledge, understand, and agree only full-time certified and authorized EISD faculty may administer medications. 

    ·     Students, Parents, and/or Guardians acknowledge, understand, and agree under no circumstance will any unauthorized medication be administered.

    ·        Students, Parents, and/or Guardians acknowledge, understand, and agree that Coaches will return all medications to the school nurse at the end of the athletic season and/or after the last competition of the school year. The school nurse will contact parents/guardians regarding the pick-up/disposal procedure of medications. Medications are never to be given directly to students.

    ·        Students, Parents,and/or Guardians acknowledge, understand, and agree that a Coach must follow the same protocols with every student, regardless of familiar relationship, unless Coach is the parent/guardian of student; wherein, the Coach can administer medication to his/her own child.

    ·        Students, Parents,and/or Guardians acknowledge, understand, and agree if Legal or Local policy conflicts with any of these protocols located herein, Texas Legal Policis will prevail followed by Edgewood ISD Local policies.  

    .

PROCEDURES FOR STUDENT ATHLETES WHO REQUIRE MEDICATION

  • ·     To provide for the health and safety of student athletes, the following procedures must be followed when a student requires an inhaler, insulinor an emergency medication (Glucagon, Epi-Pen, Diastat or any other) during after school practices or athletic events.

    ·     A current Medication Administration Request, Asthma Action Plan, Emergency Care Plan, Seizure Plan or Diabetes Management and Treatment Plan (DMTP) must be completed by the prescribing physician and on file in the school nurse's office. All medication must be in a currently prescribed pharmacy labeled bottled and clearly labeled with the student's name; name of medication, dose, and frequency of administration. Inhalers, insulin, and emergency medications for students shall be securely stored in the school nurse'soffice.

    ·     All information will be verified and the school nurse will deliver the medication to the coach and provide any required training in symptom recognition, administration and documentation. Parents/guardians of student athletes must provide a second inhaler, insulin, or emergency medication for the coach. It is the responsibility of the coach to keep all student medication stored in an easily accessible location. The coach will follow the physician's direction, EISD protocols for medication administration, and immediately contact parents in the event of a medical emergency during practices or sporting events.

     

UIL - Sudden Cardiac Arrest Awareness, Concussion Acknowledgement, Anabolic Steroids, and Acknowledgement of Rules Forms

  • Please click and read the following links, these links MUST be read by both student and parent/guardian:

    UIL SUDDEN CARDIAC ARREST AWARENESS FORM

    UIL CONCUSSION ACKNOWLEDGEMENT FORM

    UIL PARENT AND STUDENTS ANABOLIC STEROID ACKNOWLEDGEMENT FORM

    UIL ACKNOWLEDGEMENT OF RULES FORM

     I/We (Parent/Guardian and Student) understand that failure to provide accurate and truthful information on UIL forms could subject the student in question to penalties determined by the UIL.

    By placing the last four digits of the social security numbers, I/We have read all required documents of rules, policies, procedures, protocols and regulations pertaining to Edgewood ISD policies, UIL Sudden Cardiac Arrest Awareness,Concussion Acknowledgement, Parent and Student Anabolic Steroid Agreement, and Acknowledgement of Rules. 

     

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