Athletic Participation Packet
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Athletic Participation Packet

Athletic Packet- High School 2023-2024

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Part 1- COMPETITIVE ATHLETICS CONSENT FORM
The student named below has applied for participation in the interscholastic athletic program of Cedar Grove Public Schools. This permission can be granted only if the student agrees to abide by the following rules and regulations.

The applicant must become acquainted with the rules of the New Jersey State Interscholastic Athletic Association, Conference, Cedar Grove Board of Education Policies and Student/Athletes Handbook to accept the responsibility of keeping in good physical condition, attend faithfully to studies, and behave at all times in a sportsmanlike manner. The participant has the responsibility for the care and keeping of all equipment issued by the school, and for the return of the same to the Athletic Department on request. If any equipment is lost, the student shall reimburse the school at original cost for the lost equipment.

Please check the appropriate interscholastic sports that you give your child permission to participate and the season which he/she is participating AT THIS TIME.

Realizing that the below activities involve the potential for injury which is inherent in all sports, I/We acknowledge that even with the best coaching, use of the most advanced protective equipment and strict observance of rules, injuries are still a possibility. There is a possibility that these injuries can be so severe as to result in total disability, paralysis, or even death. Remember that when the physician fills out the physical form, it becomes a legal document and this information may be shared with the athletic trainer or a coach. This will be afforded the same confidentiality as other medical information.

In the event your son/daughter should suffer from a head injury/concussion, all Cedar Grove Public School Employees will follow the NJSIAA and Cedar Grove Board of Education Policies as well as the written guidelines from the NATA Position Statement on management of sport related concussions. Concussion Education will be included in this packet.
Spring Sports*
- Baseball
- Boys Spring Track
- Boys Lacrosse
- Boys Tennis
- Girls Lacrosse
- Girls Spring Track
- Golf
- Softball
Student-Athlete*
First Last
Parent-Guardian #1*
First Last
Parent-Guardian #2*
First Last
Digital Signature- Competitive Athletics Consent Form*
- By clicking here, I hereby give my consent for my child to participate in the interscholastic athletic program indicated above, sponsored by the Cedar Grove High School. It is understood that neither the Board of Education nor any of its representatives will be held responsible in any way for injuries received in this activity.
Rules and Regulations*
- By clicking here, the student-athlete listed above attests to have read and understood the rules and regulations governing participation in the athletics as listed above and agree to abide by them.

Part 2- STUDENT & EMERGENCY MEDICAL PROFILE INFORMATION
Your son/daughter has requested the privilege of taking part in our athletic program. Before he/she may take part, it is necessary for us to have your consent by completing the forms included in this packet.
Student-Athlete Name*
Kaitlyn Fahy
Gender*
- Male
- Female
Student Email*
Grade (for the 2023-2024 school year)*
Age*
Date of Birth*
Address*
Street Address City State ZIP Code
Home Phone*
Hospital In Case of Emergency:*
- No preference
- Mountainside
- St. Barnabas
- St. Joseph's
Parent/Guardian/Emergency Contact Information
Parent-Guardian #1*
First Last
Parent Email*
Work Phone*
Cell Phone*
Parent-Guardian #2
First Last
Parent #2 Email
Work Phone
Cell Phone
Alt. Contact #1
First Last
Relationship
Phone
Alt. Contact #2
First Last
Relationship
Phone
Physician/Medical Information
Physician Name*
First Last
Phone*
Address*
Street Address City State ZIP Code
Allergies- medicines, insects, et...*
Write none if you do not have any allergies.
Medications taken if any:*
Medical Conditions-Previous Injuries*
Write none if you do not have any previous injuries or medical conditions.
Athletic Waiver
The student/athlete listed above has my permission to participate in competitive school athletics at Cedar Grove High School. I hereby certify that the above information is true and accurate.
Digital Signature- Athletic Permission Form*
- I do hereby request, authorize and consent to such care which may be needed by my child as a result of injury or sickness that the School Athletic Trainer evaluate, provide immediate emergency care, treatment, and rehabilitation of an injury which is the result of school sports participation. In the case of more serious injury and I cannot be reached, I do hereby request, authorize and consent for a qualified physician to examine, diagnose, prescribe and perform the treatment necessary for the welfare of the above student athlete.

Part 3- HEALTH HISTORY UPDATE
“To participate on a school athletic squad or team, each candidate whose medical examination was completed more than 90 days prior to the first practice session shall provide a health history update of medical problems experienced since the last medical examination. This shall be completed and signed by the parent/guardian.”

SINCE your child’s “Annual Athletic Pre-Participation Physical Evaluation” was completed, has he/she experienced any of the following CHANGES:
Date of last sports physical*
Been medically advised not to participate in a sport?*
- Yes
- No
Describe in detail:*
Sustained a concussion, been unconscious or lost memory from a blow to the head?*
- Yes
- No
Describe in detail:*
Broken a bone or sprained/strained/dislocated any muscle or joints?*
- Yes
- No
Describe in detail:*
Fainted or “blacked out?”*
- Yes
- No
Was this during or immediately after exercise?*
Experienced chest pains, shortness of breath or “racing heart?”*
- Yes
- No
Describe in detail:*
Has there been a recent history of fatigue and unusual tiredness?*
- Yes
- No
Describe in detail:*
Been hospitalized or had to go to the emergency room?*
- Yes
- No
Explain in full detail:*
Since the last physical examination, has there been a sudden death in the family or has any member of the family under age 50 had a heart attack or “heart trouble?”*
- Yes
- No
Started or stopped taking any over-the-counter or prescribed medications?*
- Yes
- No
Name of medication(s)*
Been diagnosed with Coronavirus (COVID-19)?*
- Yes
- No
If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic?*
- Yes
- No
If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized?*
- Yes
- No

Part 4- Student Athlete Handbook
Both student-athlete and parent-guardian have read and understand the issues set forth in the Cedar Grove High School Student-Athlete Handbook. We agree to the follow the policies and procedures set forth in student-athlete handbook and will abide by the NJSIAA, Super Essex Conference (SEC) and Cedar Grove Board of Education policies regarding interscholastic sports at Cedar Grove High School.

We also are aware that the student athlete handbook, the NJSIAA and SEC links are on the Cedar Grove Schools website for accessibility of information, policies and procedures.
Please click the box below confirming your have read the Student Athlete Handbook*
- I have read the Student Athlete Handbook
Part 5- NJSIAA Concussion Policy Acknowledgement Form
In order to help protect the student-athletes of New Jersey, the State of New Jersey and the NJSIAA have mandated that the Cedar Grove School District, and all Cedar Grove student-athletes, parents/guardians and coaches follow the Cedar Grove Concussion Management Policy.

For up-to-date information on concussions, you can go to:
Concussions In Youth Sports or NFHS Learn.
Please click all confirming you have read and understand the NJSIAA Concussion Consent Policy.*
- I have read the Concussion Education Form Parents and Athletes
Part 6- 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.

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.
Please click the box below confirming your have read the List of Banned Substances*
- I have read the List of Banned Substances
Please click the box below confirming your have read the Steroid Testing Policy*
- I have read the Steroid Testing Policy
Please click the box below confirming your have read the Steroid Testing Protocols*
- I have read the Steroid Testing Policy
Part 7- Sudden Cardiac Death in Young Athletes
All student-athletes and their parents need to read and become familiar with the Sudden Cardiac Death in Young Athletes brochure.
Please click the box below confirming your have read the Sudden Cardiac Death in Young Athletes Brochure*
- I have read the Sudden Cardiac Death in Young Athletes Brochure
Part 8- Opioid Use and Misuse Fact Sheet
In accordance with N.J.S.A. 18A:40-41.10, public school districts, approved private schools for students with disabilities, and nonpublic schools participating in an interscholastic sports program must distribute the Opioid Use and Misuse Educational Fact Sheet to all student-athletes and cheerleaders. In addition, schools and districts must obtain a signed acknowledgement of receipt of the fact sheet from each student-athlete and cheerleader, and for students under age 18, the parent or guardian must also sign.

In accordance with the law, the fact sheet must be distributed and a sign-off sheet completed and collected for each student-athlete or cheerleader prior to the first official practice session of the spring 2018 athletic season (March 2, as designated by the New Jersey State Interscholastic Athletic Association), and annually thereafter prior to the student’s first official practice of the school year.
Please click the box below acknowledging that you received and reviewed the Educational Fact Sheet on the Use and Misuse of Opioid Drugs.*
- I have read and reviewed the Educational Fact Sheet on the Use and Misuse of Opioid Drugs
Part 9- NJSIAA OPIOID POLICY ACKNOWLEDGEMENT
Acting to address the increased risk of opioid abuse among high school athletes, the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (NJCARES) and the New Jersey State Interscholastic Athletic Association (NJSIAA) announced a new partnership to educate student athletes and their parents/guardians on addiction risks associated with sports injuries and opioid use.

This educational initiative, spearheaded by Attorney General Gurbir Grewal and approved by the Executive Committee of the NJSIAA, is a collaborative effort to use video programming to raise awareness among high school athletes that they face a higher risk of becoming addicted to prescription pain medication than their fellow students who do not play sports.

Please review the Opioid video by clicking on the following link: Opioid Video
Please click the box below acknowledging that you viewed the Opioid Video.*
- We have watched the Opioid Video

Declaration
I declare that my signature below signifies my understanding and concurrence with the information completed in the Athletic Packet, which includes:
- Competitive Athletics Consent Form
- Student/Emergency Contact Information
- Student Athlete Handbook
- Concussion Policy
- Steroid Consent to Random Testing
- Sudden Cardiac Death in Young Athletes
- Opioid Use and Misuse Fact Sheet
DECLARATION*
- I declare to my understanding and concurrence with the information completed in the Sports Permission Packet, which includes: Competitive Athletics Consent Form, Student/Emergency Contact Information, Student Athlete Handbook, Concussion Policy, Steroid Consent to Random Testing, Sudden Cardiac Death in Young Athletes and Opioid Use and Misuse Fact Sheet.
Annual Athletic Pre-Participation Packet
Physicals must be performed within the 365 days prior to the first official starting day of that particular sport season” The Fall start date is August 10th, 2022. Physicals after August 10th, 2022 will be accepted or physicals from the current year.

Any Physical that expires during the course of the season must be updated immediately to avoid lapse in participation.

Please download the below form and return to the Nurse.

Annual Athletic Pre-Participation Physical Form
Student/Athlete's Name*
First Last
Date*
Student/Athlete Digital Signature*
Parent/Guardian Name*
First Last
Date*
Parent/Guardian Digital Signature*

Athletic Participation Packet
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