P.O. Drawer 1300, Los Lunas, NM 87031

(Los Lunas HS & Los Lunas MS): Stephanie Lucero, Athletic Secretary, (505) 866-8397, snlucero@llschools.net

Wilson Holland, Athletic Director, wholland@llschools.net, Fax: (505) 865-6022

(Valencia HS & Valencia MS): Patricia Torrez, Athletic Secretary, (505) 866-8398, ptorrez@llschools.net

Pre-Participation Physical Exam Packet **PLEASE PRINT CLEARLY**

Current Physical dated after April 1 (NMAA Bylaw)

Parent/Guardian, please fill out prior to examination.

Student Athlete Name (Last, First, M.I.):_____________________________________________ Home Address:_________________________________________________________________ Grade:______________Age:_____________ID#:______________________________________ Name of Parent/Guardian:________________________________________________________ Home Address:_________________________________________________________________ Phone: (H)______________________Work:__________________(C)_____________________ Emergency Contact (other than parents): Name:_______________________________________________________Relationship:_______ Phone: (H)__________________________Work:__________________(C)_________________ Address:______________________________________________________________________

Sport/Activity Student will participate in (Check all that apply)

FALL WINTER SPRING Football Boys Basketball Baseball

Cross Country Girls Basketball Boys Golf Boys Soccer Wrestling Girls Golf Girls Soccer Swimming Softball Volleyball JROTC Tennis

JAGZZ Boys Track Cheer Girls Track

Tigerettes

Please answer all health history questions on the following page PRIOR to your visit to the doctor. Please fill in the student athlete’s personal information on each page of the form and return the entire packet, along with a copy of your insurance card, to the school’s athletic trainer.

Certified Athletic Trainers: LLHS: Nicholas Gutierrez VHS: Joshua Sears

TRAINER

P.O. Drawer 1300, Los Lunas, NM 87031

(Los Lunas HS & Los Lunas MS): Stephanie Lucero, Athletic Secretary, (505) 866-8397, snlucero@llschools.net Wilson Holland, Athletic Director, wholland@llschools.net, Fax: (505) 865-6022 (Valencia HS & Valencia MS): Patricia Torrez, Athletic Secretary, (505) 866-8398, ptorrez@llschools.net

CLEARED TO PARTICIPATE & EMERGENCY INFORMATION FORM

Student Athlete Name:_______________________________________________Grade:____ID#:_______________

This student has turned in the following information to the Athletic Trainer. To the best of my knowledge it is complete and accurate and this student is now cleared to begin practicing/participating. The Head Coach is responsible for having this document readily available for travel.

Emergency Information:

Mother’s Name:____________________________________Phone:(H)__________(W)__________(C)__________ Father’s Name:_____________________________________Phone: (H)_________(W)___________(C)_________ Home Address:______________________________________________________________________________________ Emergency Contact (other than parent): Name:_______________________________(relationship) Phone:____________(C)__________ Name:_______________________________(relationship) Phone:____________(C)__________

Medical History: ALLERGIES:________________________________________________HISTORY OF ANAPHYLAXIS:__Y__N

IMMUNIZATIONS: ___(up to date) Last Tetanus Immunization:____________ Significant Medical History Information (please indicate any history of asthma, hypertension, previous head injury, unequal pupil size, etc.) __________________________________________________________________________________________________________________________________________________________________________________________ Current Medical Conditions:_________________________________________________________________________________ _____________________________________________________________________________________________ Current Medications (if asthma medication, please indicate if needed prior to sports): _____________________________________________________________________________________________ Does the athlete wear contacts?_____Y____N Does the athlete require eye protection while playing?_____Y____N Student’s Primary Physician/Provider (for follow-up, if necessary):_______________________________________ Address:_______________________________________________________________________Phone:_________ Hospital Preference:___________________________(1st choice)_______________________________(2nd choice) Insurance Provider:___________________________________________________Policy #:___________________

OFFICE USE ONLY: LLHS/VHS Athletic Trainer:____________________________________________________________Date:______________ (There may be other circumstance that make this student ineligible and preclude participation at this time and/or require petitioning: Foreign exchange, transfer student, grades, attendance, etc.)

TRAINER

ATHLETIC PRE-PARTICIPATION PHYSICAL EXAMINATION FORM Part A: Health History Form Student Athlete Name Gender DOB

1. Has a doctor ever denied or restricted your participation in sports for any reason?

D Yes D No 23. Has a doctor ever told you that you have asthma or allergies?

D D No

2. Do you have an ongoing medical condition (like diabetes or asthma)?

D Yes D No 24. Do you cough, wheeze, or have difficulty breathing during or after exercise?

D Yes D No

3. Are you currently taking any prescription or nonprescription (over-the-counter) medicines or pills?

D Yes D No 25. Is there anyone in your family with asthma? D Yes D No

4. Do you have allergies to medicines, pollens, foods, or stinging insects?

D Yes D No 26. Have you ever used an inhaler or taken asthma medicine?

D Yes D No

5. Have you ever become dizzy or passed out DURING or AFTER exercise?

D Yes D No 27. Were you born without or are you missing a kidney, an eye or testicle, or any other organ?

D Yes D No

6. Have you ever had discomfort, pain, or pressure in your chest during or after exercise?

D Yes D No 28. Have you had a severe viral infection such as infectious mononucleosis (mono) or myocarditis in the last month?

D Yes D No

7. Do you get more tired than your friends do during exercise?

D Yes D No 29. Do you have any rashes, pressure sores or other skin problems?

D Yes D No

9. Has a doctor ever told you that you have: DHigh Blood Pressure DHeart Murmur DHeart Infection DHigh Cholesterol (Check all that apply)

D Yes D No 30. Have you had a herpes infection? D Yes D No

31. Have you had a head injury or concussion? D Yes D No

32. Have you been hit in the head and been confused or lost your memory?

D Yes D No

10. Has a doctor ever ordered a test for your heart?(for example ECG, echocardiogram)

D Yes D No 33. Have you ever had a seizure? D Yes D No

11. Has anyone in your family ever died for no apparent reason?

D Yes D No 34. Do you have headaches with exercise? D Yes D No

12. Does any one in your family have a heart problem?

D Yes D No 35. Have you ever had numbness or tingling or weakness in your arms, or legs?

D Yes D No

13. Has a family member or relative died of heart problems or sudden death before the age of 50?

D Yes D No 36. Have you ever been unable to move your arms or legs after being hit or fallen?

D Yes D No

14. Have any of your relatives ever had any one of the following conditions? Hypertrophic cardiomyopathy, dilated cardiomyopathy, Marfan’s syndrome or Long QT Syndrome or a significant heart arrhythmia?

D Yes D No 37. When exercising in the heat, do you have severe muscle cramps or become ill?

D Yes D No

38. Has a doctor told you that you or someone in your family has sickle cell trait or sickle cell disease?

D Yes D No

15. Have you ever had racing of your heart or skipped heartbeats?

D Yes D No 39. Have you had any problems with your eyes or vision? D Yes D No

40. Do you wear glasses or contact lenses? D Yes D No

16. Have you ever spent the night in a hospital?

D Yes D No 41. Do you wear protective eyewear such as goggles or a face shield?

D Yes D No

17. Have you ever had surgery? D Yes D No 42. Are you unhappy with your weight? D Yes D No

18. Have you ever had an injury, like a sprain, muscle or ligament tear or tendonitis that caused you to miss a practice or game? D Yes D No If yes circle affected area below:

19. Have you had any broken or fractured bones or dislocated joints? D Yes D No If yes circle affected area below:

20. Have you had a bone or joint injury that required x-rays, MRI, CT, surgery, injections, rehabilitation, physical therapy, a brace, a cast or crutches? D Yes D No If yes circle affected are below:

43. Are you trying to gain or lose weight? D Yes D No

44. Has anyone recommended you change your weight or eating habits?

D Yes D No

45. Do you limit or carefully control what you eat? D Yes D No

46. Do you have concerns that you would like to discuss with the doctor/health care provider?

D Yes D No

FEMALES ONLY: 47. Have you ever had a menstrual period? DYes DNo 48. How old were you when you had your first menstrual period? 49. How many periods have you had in the last 12 months?

Head

Neck

Shoulder

Upper arm

Elbow Calf or shin

Hand

Chest

Explain “Yes” answers here (use the back of the form if necessary):

Upper back

Lower Back

Forearm Thigh Knee Hip Ankle Foot Toes

21. Have you ever had a stress fracture? D Yes D No

No

No

22. Have you ever been told that you have or have had an x-ray for atlantoaxial (neck) instability?

D Yes D

23. Do you regularly use a brace or assistive device?

D Yes D

Last updated 9/10/2007

TRAINER

ATHLETIC PRE-PARTICIPATION PHYSICAL EVALUATION FORM Part B: Physical Examination Athlete Name Gender DOB

TO BE COMPLETED BY THE EXAMINING PHYSICIAN OR PROVIDER -PLEASE COMPLETE BOTH PAGES

Student Athlete Name (Last, First, M.I.): DOB: Height Weight:

BMI %ile Pulse: Blood Pressure: / Blood (Per CDC %ile charts) (Recheck if elevated) / Pressure %ile

/ (per NIH guidelines)

Vision: R20/ L20/ Corrected: Y / N Pupils : Equal Unequal

MEDICAL Normal (circle one) Abnormal Findings/Comments

Appearance YES NO

Eyes/Ears/Nose/Throat YES NO

Hearing YES NO

Lymph nodes YES NO

Heart (auscultation should be done supine and standing- abnormal findings require referral for further evaluation)

YES NO

Murmurs YES NO

Pulses YES NO

Lungs: Auscultation YES NO

Abdomen: Assessment (incl. liver, spleen) YES NO

Genitourinary (males only) YES NO

Skin YES NO

MUSCULOSKELETAL

Neck YES NO

Back YES NO

Shoulder/Arm YES NO

Elbow/Forearm YES NO

Wrist/Hand/Fingers YES NO

Hip/Thigh YES NO

Knee YES NO

Leg/Ankle YES NO

Foot/Toes YES NO

NOTES:

Does Athlete wear contacts? D Yes D No Does Athlete require eye protection while playing? D Yes D No

Student MAY participate in the following types of sports (CHECK ALL THAT APPLY): D ALL FORMS OF SPORTS D CONTACT/COLLISION D NON-CONTACT/STRENUOUS D LIMITED CONTACT D NON-CONTACT/NON-STRENUOUS D STUDENT CLEARED FOR PARTICIPATION D STUDENT CLEARED FOR PARTICIPATION PENDING D STUDENT NOT CLEARED FOR PARTICIPATION Name of Physician/Provider (print/type) Date

Signature of Physician /Provider

Student’s Primary Physician/Provider (for follow up, if necessary):

Last updated 9/10/2007

TRAINER

Permission to Participate and Authorization for Medical Services

The parent/guardian of , who attends Los Lunas Schools, herby (Name of Student)

gives permission for this student to participate in any an all trips, activities, practices, contests, etc., of and by the Los Lunas Schools Athletic Program.

Bus and as provided Type of Transportation

The parent/guardian is reminded that every reasonable precaution will be taken to provide for the safety and care of the student. In the even of an accident requiring emergency care, a reasonable effort will be made to notify the parent/guardian. The parent/guardian hereby assumes financial responsibility for all medical care including, but not limited to, hospitalization and medication treatments provided. A copy of this permission form will accompany trip sponsor. The parent/guardian and student do hereby accept, by agreement, the responsibilities related to the following statement of PROHIBITED ACTIVITIES:

A. A person shall not by any conduct, act, force, or threat deprive another of the exercise of personal rights and responsibilities, nor engage in any conduct which causes disruption of any lawful mission, process, or function of the school.

B. A student shall not intentionally cause or attempt to cause damage to school or private property or attempt to steal school or private property. If a student should cause willful damage to school property, the school will seek restitution from the student and parent/guardian.

C. A student shall not intentionally cause or attempt to cause physical injury to any person or behave in such a way that could reasonably cause physical injury to another.

D. A student shall not possess, handle, or transmit nay object that could reasonably be considered a weapon.

E. A student shall not possess, use transmit, or be under the influence of any controlled substance as defined by the Los Lunas Schools Policies. Use of a drug authorized by a medical prescription from a registered physician, and in accordance with professional instruction, shall not be considered a violation of this rule. Students taking medication should so advise the chaperones.

F. Any violation of local, state, or federal laws or the Los Lunas Schools Policies on school trips will subject the student to disciplinary action by school authorities.

I understand that it is the responsibility of the parent/guardian and student to give all medications which the student is authorized to take to the sponsor of the activity. We agree to provide a new physician’s statement if there is any change in the medication, dosage, administration time, administration route, or special instructions regarding the medication. I further authorize and hereby request that the medications listed on the previous page be given to the student according to the properly labeled instructions.

I authorize the Los Lunas Schools to release to the New Mexico Activities Association any information needed to determine eligibility.

I authorize the school or its designee to obtain any medical care including care that may become necessary to the student in the course of extracurricular/co-curricular activities including travel.

I also agree not to hold the school or anyone acting in its behalf responsible for any injury occurring to the above named student in the course of such extracurricular/co-curricular activities including travel.

I understand that all rules and policies that govern student conduct in the Los Lunas School also apply at all times through the duration of all trips, activities, practices, contests, etc. Any violation of LLS rules and policies may result in any of these or other disciplinary actions as defined by the LLS Schools Board and Education Policies:

The parent/guardian will be called upon to assume responsibility for any and all damages that may result from the prohibited action of the student.

The student will be excluded from any future trip. The student will be excluded from participation in future activities.

I/ we parent(s) / guardian(s) and student are aware that preparation for and participation in interscholastic athletics involves many risks or serious and permanent injury to the student- athlete. We understand and acknowledge the danger of these severe injuries as inherent in physical activities which may involve vigorous physical contact.

I/ We parent(s) / Guardian(s) (as the party legally responsible for the above-named student) and the student have completely read, fully understand, and voluntarily accept and agree to all of the above statements, terms and conditions.

Signature of Parent/ Guardian Date Signature of Athletic Director Date

Signature of Student Athlete Date

TRAINER

A Fact Sheet for Athletes and Parents

WHAT IS A CONCUSSION?

A concussion is an injury that changes how the cells in the brain normally work. A concussion is caused by a blow to the head or body that causes the brain to move rapidly inside the skull. Even a “ding,” “getting your bell rung,” or what seems to be a mild bump or blow to the head can be serious. Concussions can also result from a fall or from players colliding with each other or with obstacles, such as a goalpost.

WHAT ARE THE SIGNS AND SYMPTOMS OF A CONCUSSION?

Observed by the Athlete

Headache or “pressure” in head Nausea or vomiting Balance problems or dizziness Double or blurry vision Bothered by light Bothered by noise Feeling sluggish, hazy, foggy, or groggy Difficulty paying attention Memory problems Confusion Does not “feel right”

Observed by the Parent / Guardian

Is confused about assignment or position Forgets an instruction Is unsure of game, score, or opponent Moves clumsily Answers questions slowly Loses consciousness (even briefly) Shows behavior or personality changes Can’t recall events after hit or fall Appears dazed or stunned

WHAT TO DO IF SIGNS/SYMPTOMS OF A CONCUSSION ARE PRESENT

Athlete

TELL YOUR COACH IMMEDIATELY! Inform Parents Seek Medical Attention Give Yourself Time to Recover

Parent / Guardian

Seek Medical Attention Keep Your Child Out of Play Discuss Plan to Return with the Coach

It’s better to miss one game than the whole season.

Give yourself time to get better. If you have had a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have a second concussion. Second or later concussions can cause damage to your brain. It is important to rest until you get approval from a doctor or health care professional to return to play.

TRAINER

Page 2

RETURN TO PLAY GUIDELINES UNDER THE SB1

1. Remove immediately from activity when signs/symptoms are present.

2. Must not return to full activity prior to a minimum of one week..

3. Release from medical professional required for return.

4. Follow school district’s return to play guidelines.

5. Coaches continue to monitor for signs/symptoms once athletes return to activity.

REFERENCES ON SENATE BILL 1 AND BRAIN INJURIES

Senate Bill 1: www.nmact.org

-or- http://legis.state.nm.us/Sessions/10%20Regular/final/SB0001.pdf For more information on brain injuries check the following websites: http://www.nfhs.org/sportsmed.aspx www.cdc.gov/ConcussionInYouthSports www.stopsportsinjuries.org/concussion http://www.ncaa.org

SIGNATURES By signing below, I acknowledge that I have received and reviewed the attached NMAA’s

Concussion in Sports Fact Sheet for Athletes and Parents. I also acknowledge and I understand the risks of brain injuries associated with participation in school athletic activity, and I am aware of the State of New Mexico’s Senate Bill 1; Concussion Law.

Athlete’s Signature Print Name Date

Parent/Guardian’s Signature Print Name Date

TRAINER

33

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

ATHLETIC SUBSTANCE ABUSE, ALCOHOL, TOBACCO

Philosophy

Athletics are an integral part of the educational process, providing students with

opportunities to further develop their unique capabilities, interests, and needs beyond the

classroom. Participation in athletics is a PRIVILEGE offered to and earned by students.

Because participants are representatives of their school and community, their conduct is

expected to exemplify high standards at all times. Suspension from athletics can be

affected by the principal/coach and does not require a due process hearing.

A. Use and /or Possession of Controlled Substances, Alcohol, and Tobacco Products are

prohibited. (A citation, police report or discipline referral may be used to show evidence)

Consequences for violations during school year and/or organized summer activities

First Offense Tobacco - Suspension from participation – 15 school days

Alcohol/Drugs - Suspension from participation – 45 school days *(First time offenders may have their suspensions reduced 50% by completing a certified drug/alcohol prevention program. Page 25)

Second Offense Tobacco - Suspension from participation – 30 school days

Alcohol/Drugs - Suspension from participation – 90 school days

Third Offense Tobacco - Suspension from participation – 60 school days

Alcohol/Drugs - Suspension from participation – 180 school days

B. Sale or Distribution of Controlled Substances.

1. Student ineligible to participate in extracurricular activities for 180 school days or

longer under special circumstances.

C. End of season is defined by the NMAA (13.1) as follows:

• A team/individual does not qualify for play-offs.

• A team/individual is eliminated from play-offs. (Non-varsity seasons end with

the team’s last event.)

I, wish to try out for and/or participate in school sponsored

interscholastic athletics. I agree to follow the standards of conduct and procedures as set

forth for interscholastic athletics with Los Lunas Schools. I understand that if I violate these

standards, I will be subject to such penalties as stated, including exclusion from the

opportunity to participate in interscholastic athletics.

Student Signature Date

Parent Signature Date

First time offenders may have their suspensions reduced (School Principal) 50% by completing a certified drug/alcohol prevention

program. (School Counselor and/or Outside Accredited Agency)

COACH

34

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

Athlete Code of Ethics • Fair, hard play at all times, showing respect for opponents, coaches, officials and

spectators. • Conduct with the highest degree of character on and off the field. • Faithful completion of schoolwork as practical evidence of commitment to school and

team. • Complete observance of all training rules and school policies. • Give opponents the credit for their ability and the respect you would hope to receive in

return. • Be modest and considerate in victory; be gracious in defeat. • Realize it is an honor and a privilege to represent Los Lunas Schools. • Realize that team success comes before individual recognition. • Sportsmanship and competition are the primary reasons for high school athletics • Adhere to the rules and expectations of the Head Coach

Conduct Unbecoming an Athlete: Athletes will not display behavior on or off the

playing field which, in the opinion of the coaching staff, is considered insubordinate or

inappropriate to standards of conduct, attitude or sportsmanship.

Sanction: Discipline will be handled by the coach and or the school Administration. The

range of discipline goes from verbal warning to dismissal from the team.

ACKNOWLEDGMENT FORM STUDENT

(Please sign and return to your coach.)

I, wish to try out for and/or participate in school

(Print Student’s Name)

sponsored interscholastic athletics. I agree to follow the standards of conduct and procedures as

set forth for interscholastic athletics in the Los Lunas School District. I understand that if I violate

these standards, I will be subject to such penalties as stated, including exclusion from the

opportunity to participate in interscholastic athletics.

Student Signature Date

PARENT/GUARDIAN

I agree to permit my son/daughter to try out for and/or participate in school-sponsored

interscholastic athletics. I have read the Los Lunas School Athletic Handbook and agree to

support the standards of conduct and procedures contained therein as a condition of my

son/daughter’s participation in interscholastic athletics within the Los Lunas School System. I

understand that if my son/daughter violates the handbook’s standards of conduct, he/she will be

subject to penalty as outlines in the handbook, including exclusion from the opportunity to

participate in interscholastic athletics. I further understand that selection or assignment to a team

does not constitute any guarantee (written or implied) that my son/daughter will receive any

playing time.

Parent Signature Date

COACH

35

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

LOS LUNAS PUBLIC SCHOOLS PARENT/GUARDIAN CODE OF EXPECTATIONS FOR ATHLETICS

The essential elements of character-building and ethics in sports are embodied in the concept of

sportsmanship as referenced in “Pursuing Victory With Honor” and in the six core principles of character

education: trustworthiness, respect, responsibility, fairness, caring and citizenship. The highest potential of

sports is achieved when competition reflects these principles. Please be advised the Los Lunas Public

Schools has a code of expectations for all parents/guardians participating in the athletic experience. Your

cooperation in adhering to the following obligations as a parent/guardian at athletic events is appreciated

and necessary to provide the most quality experience for every person participating.

I will do my part to make athletics and activities a positive experience for everyone involved (i.e.

participants, coaches, officials and spectators)

I will learn the policies of school district, school and program and do my best to understand

and appreciate the rules of the contest

I will encourage good sportsmanship by showing respect and courtesy and by being a positive

role model at every event and practice

I will not engage in any unsportsmanlike conduct with any official, coach, player, parent or

staff member, such as taunting or using profane language or gestures

I will demand a safe and healthy environment that is free from drugs, tobacco and alcohol and

will refrain from any use at all athletic events

I will not engage in disparaging dialogue or taunting behavior with officials, players, coaches,

parents and other spectators before, during and after all events

I will respect the decisions and authority of officials during competitions

I will respect the property and equipment used at any sports or school facility

I will show appreciation for an outstanding play by either team

I will applaud a good effort in both victory and defeat emphasizing the positive

accomplishments and learning from the mistakes

In addition, parents of participants in the Los Lunas Public Schools athletic program are expected to

adhere to the following obligations to fully ensure the best possible environment for their child.

I will insist my child treat other players, coaches, officials and fans with respect and

courtesy regardless of race, sex, creed or ability

I will help my child learn that success is measured by the development of skills, not by winning

or losing

I will communicate with the coach at the appropriate time and place when I have a concern

regarding my child (not during games and/or practice)

I will inform the coach of any physical disability or ailment that may affect the safety of my

child or the safety of others

I will refrain from coaching my child or other players during games and practices unless I am

an official coach

I will place the emotional and physical well-being of my child ahead of my personal desire to

win

I will never ridicule or yell at my child or other participant for making a mistake or blame my

player’s teammates or coaches for success or failure in the athletic setting I will teach my child to respect the decisions of administrators, coaches and officials and will

positively model this same behavior

I will reinforce the school district’s substance abuse policies with my child and refrain from

any use of alcohol and other drugs before or during contests

I will follow the chain of command and the district’s grievance procedure when trying to rectify

and or resolve and issue and or concern

COACH

36

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

In the event an adult fails to adhere to and uphold these obligations, the school administration and the

school district reserves the right to impose sanctions including disciplinary action that may include, but is

not limited to, temporary and/or permanent removal from the activity and expulsion from all future

events.

The undersigned parent/guardian and student state that:

We have read the Los Lunas Public Schools (LLPS) Athletic Handbook and Code and

understand its terms and conditions

We understand it is our responsibility to be aware of and adhere to additional standards,

rules, and requirements of the school sport program/activity group, the school the student attends and

participates, the Los Lunas Public Schools and the New Mexico Activities Association.

We agree to be bound by the terms, conditions, rules, and standards of the LLPS Athletic

Code.

We understand that it is our responsibility to keep this document and refer to it throughout

the year when specific issues or questions arise.

We understand that the LLPS handbook is accessible on the LLPS Athletic Department

website. All revisions, corrections or additions will be posted regularly on the website. The website

document will be considered current and takes precedence over any and all previously printed

handbook editions. It is the reader’s responsibility to refer to the document on the website for updates

and new information.

Student Printed Name Date

Parent/Guardian Printed Name Date

Parent/Guardian Signature Date

COACH

37

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

Los Lunas School Board Policy 7.12

PROHIBITING HAZING

The Board of Education finds that practices known under the term “hazing” are dangerous to the

physical and psychological welfare of students, and should be prohibited in connection with all

school activities.

Section 1.01 7.12.1. DEFINITION

Hazing includes, but is not limited to,

1. Engaging in any offensive or dangerous physical contact, restraint, abduction, or isolation

of a student, or

2. Requiring or encouraging a student to perform any dangerous, painful, offensive, or

demeaning physical or verbal act, including the ingestion of any substance, exposure to the

elements, deprivation of sleep or rest, or extensive isolation, or

3. Subjecting a student to any dangerous, painful, offensive, or demeaning conduct

reasonably likely to create extreme mental distress, as a condition of membership in, or initiation

into, any class, team, group, or organization sponsored by, or permitted to operate under, the

auspices of, a school of the School District, or for similar or related purposes, provided, that such

conduct shall not be considered hazing when it is a recognized and integral part of the particular

sport or activity.

7.12.2. PROHIBITION

Hazing is prohibited in all schools of the School District, whether on or off school property, and

whether during or outside school hours.

7.12.3. ENFORCEMENT AND REPORTING

School officials, employees, and volunteers

1. Shall not permit or tolerate hazing;

2. Shall intervene to stop hazing that is threatened, found, or reasonably known or

suspected to be occurring; and

3. Shall report known or suspected hazing to the school principal or the

Superintendent.

Any student who believes he or she has been the victim of hazing shall report the matter

to the school principal or the Superintendent.

COACH

38

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

7.12.4. Investigation

1. All reports of hazing shall be investigated promptly by the school principal or his/her

designee. Where violations of criminal law may have occurred, the principal, in consultation

with the Superintendent or his/her designee shall report the matter to the appropriate law

enforcement agency.

2. Upon completion of the investigation, the principal shall submit a written report on the

investigation and its results to the Superintendent.

7.12.5. Discipline

1. Students found to have engaged in hazing shall be subject to discipline by school or

District authorities according to applicable procedural requirements. Such discipline may

include suspension or expulsion.

2. Employees who fail to discharge their duties under this policy, as set forth in paragraph

C, shall be subject to discipline according to applicable procedural requirements. Such discipline

may include reprimand, suspension, discharge, or termination.

I have read and understand Los Lunas School Board Policy 7.12

Student Printed Name Date

Student Signature

Parent/Guardian Printed Name

Parent/Guardian Signature Date

Head Coach Signature Date

Copy will be kept on file in the Athletic Office.

COACH

39

LOS LUNAS SCHOOLS ATHLETIC HANDBOOK

I , am aware the Los Lunas (Students Name)

Schools Athletic Handbook is available on line on the Los Lunas Schools website www.llschools.net . I

acknowledge that I am responsible for knowing the contents and understanding all polices in the Los

Lunas Schools Athletic Handbook. I am also aware that I can request a hard copy of the Athletic

Handbook from the athletic office.

(Students Signature) (Date)

I , am aware the Los Lunas (Parent/Guardian Name)

Schools Athletic Handbook is available on line on the Los Lunas Schools website www.llschools.net . I

acknowledge that I am responsible for knowing the contents and understanding all polices in the Los

Lunas Schools Athletic Handbook. I am also aware that I can request a hard copy of the Athletic

Handbook from the athletic office.

(Parent/Guardian Signature) (Date)

COACH

PO Drawer 1300 Los Lunas, New Mexico 87031

Phone: (505) 866-8397 or (505) 866-8398 Fax: (505) 865-6022

Dana Sanders Superintendent

Wilson Holland Director of Athletics

Acknowledgement of Risk

Both the student athlete and a parent or guardian must read carefully and sign.

Student I am aware playing or practicing to play in any sport can be a dangerous activity involving risk or injury. I understand that the dangers and risks of playing or practicing to play in an athletic event includes, but is not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury to virtually all bones, joints, ligaments, muscles, tendons, and other aspects of the muscular skeletal system, and serious injury or impairment to other aspects of my body, general health and well-being.

I understand that the dangers and risks of playing or practicing to play an athletic event may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life.

Because of the dangers of participating in athletic activities, I recognize the importance of following coach’s instructions regarding playing techniques, training, and other team rules, etc., and to agree to obey such instructions.

I have read and understand the above athletic participation contract and acknowledgement of risk.

Student Signature Date

Parent/Guardian Signature Date

COACH

PO Drawer 1300 Los Lunas, New Mexico 87031

Phone: (505) 866-8397 or (505) 866-8398 Fax: (505) 865-6022

Dana Sanders Superintendent

Football Helmet Warning Label Acknowledgement Form:

Warning: No helmet can prevent head injuries such as concussion, paralysis and death.

For Riddell helmets:

Wilson Holland Director of Athletics

WARNING: NO HELMET CAN PREVENT SERIOUS HEAD OR NECK INJURIES A PLAYER MIGHT RECEIVE WHILE PARTICIPATING IN FOOTBALL. Do not use this helmet to butt, ram or spear an opposing player. This is in violation of the football rules and such use can result in severe head or neck injuries, paralysis or death to you and possible injury to your opponent. Contact in football may result in CONCUSSION-BRAIN INJURY which no helmet can prevent. Symptoms include: loss of consciousness or memory, dizziness, headache, nausea or confusion. If you have symptoms, immediately stop playing and report them to your coach, trainer and parents. Do not return to a game or practice until all symptoms are gone and you have received medical clearance. Ignoring this warning may lead to another and more serious or fatal brain injury.

For Schutt helmets:

WARNING: Keep your head up. Do not butt, ram, spear, or strike an opponent with any part of this helmet or face guard. This is a violation of football rules and may cause you to suffer severe brain or neck injury, including paralysis or death and possible injury to your opponent. Contact in football may result in Concussion/Brain injury which no helmet can prevent. Symptoms include: loss of consciousness or memory, dizziness, headache, nausea, or confusion. If you have symptoms, immediately stop and report them to your coach, trainer, and parents. Do not return to a game or contact until all symptoms are gone and you receive medical clearance. Ignoring this warning may lead to another and more serious or fatal brain injury. NO HELMET SYSTEM CAN PROTECT YOU FROM SERIOUS BRAIN AND/OR NECK INJURIES INCLUDING PARALYSIS OR DEATH. TO AVOID THESE RISKS, DO NOT ENGAGE IN THE SPORT OF FOOTBALL.

I acknowledge that I have read and understand the football helmet warning labels.

Parent/Guardian Signature Date

Student Athlete Signature Date

COACH

Dana Sanders-Superintendent Brian Baca-Deputy Superintendent Wilson Holland-Director of Athletics

Los Lunas Schools Athletic Department

Social Media Directive & Guidelines for Student Athletes & Parents/Guardians Participating in sports for Los Lunas Schools is a privilege. Student athletes must be positive role models in the community. As leaders, you have the responsibility to represent your team, your school, and yourselves in a positive manner at all times. Occasionally this means doing things that may be an inconvenience to you and unpopular. Modeling positive behavior and following the LLS social media guidelines will no doubt benefit your team. Facebook, Twitter, Instagram, snapchat and other social media sites have increased in popularity globally, and used by the majority of student athletes around this great country. Los Lunas School’s student athletes should be aware that third parties, including the media, teachers, coaches, school officials and future employers could easily access your profiles and view all personal information. This includes all pictures, videos, comments and post. Inappropriate material found by third parties affects the perception of the student athletes, the athletic department and Los Lunas Schools. This can also be detrimental to student athlete’s future employment options and opportunities. Examples of inappropriate and offensive behaviors concerning in online communities may include depictions or presentations of the following:

• Photos, videos, comments or post showing the personal use of alcohol, drugs and tobacco e.g., no holding cups, cans, shot glasses, drug paraphernalia etc.

• Photos, videos, and comments that are of sexual nature. This includes links to websites of a pornographic nature and other inappropriate material.

• Pictures, videos, comments or post that condone drug-related activity. This includes but is not limited to images that portray the personal use of drugs and drug paraphernalia.

• Content online that is unsportsmanlike, derogatory, demeaning or threading toward any other individual or entity (examples: derogatory comments regarding your school and/or another school; taunting comments aimed at a student athlete, coach or team and derogatory comments against race and/or gender etc). No post should depict or encourage unacceptable, violent or illegal acuities (examples: hazing, sexual harassment/assault, gambling, discrimination, fighting, vandalism, academic dishonesty, underage drinking, and illegal drug use).

• Content online that would constitute a violation of LLS Board Policy, LLS Athletic & Student Handbook and NMAA bylaws.

COACH

Dana Sanders-Superintendent Brian Baca-Deputy Superintendent Wilson Holland-Director of Athletics

If a student‐athlete’s profile and its content is inappropriate in accordance with the above behaviors, he/she will be subject to the following penalties: Conduct Unbecoming an Athlete: Athletes will not display behavior on or off the playing field, which in the opinion of the coaching staff, considered insubordinate or inappropriate to standards of conduct, attitude or sportsmanship. Sanction: The coach and/or school administration will handle discipline. Discipline can range from a verbal warning to dismissal from the team. For your own safety, please keep the following recommendations in mind as you participate in social media websites:

• Set your security settings so that only your friends can view your profile. • You should not post your email, home address, local address, telephone number(s), or other

personal information as it could lead to unwanted attention, stalking, identity theft, etc • Be aware of who you add as a friend to your site many people are looking to take advantage of

student‐athletes or to seek connection with student‐athletes. • Consider how the above behaviors may reflect in all social media applications.

If you are ever uncertain of the appropriateness of your online public material, consider whether it upholds and positively reflects your own values and ethics as well as the Los Lunas Schools Athletic Department’s and Los Lunas Schools. Remember always present a positive image and do not embarrass yourself, your team, your family or Los Lunas Schools. By signing below you affirm that you have read and understand the LLS Athletic Department Social Media Directive and Guidelines. In addition, you affirm that failure to adhere to the directives and guidelines may result in consequences that include suspension from your athletic team, and you may be subject to additional penalties imposed by your coach, school and/or district administrators (Student Athletes & Parents). Student Print Name:____________________________________________________ID#:____________________ Student Signature:_____________________________________________________Date:___________________ Parent Signature:______________________________________________________Date:___________________

COACH