In consideration of my participation in Guerin Catholic High School Athletic Programs, I agree to be bound by each of the following: 1. Eligibility: I agree to comply with the rules of participation as defined in the Guerin Catholic High School (GCHS) Student-Athlete Handbook. 2. Readiness to Participate: I will only participate in those GCHS athletic activities for which I believe I am physically and psychologically prepared. Prior to participation, I will have prepared myself physically and mentally to perform only those activities which I have accomplished to the degree of confidence necessary to assure that I can perform them by myself, and without injury and improve the quality of my and my teammates' experience with GCHS Athletics. I agree that I will follow all reasonable directions and commands of my coaching staff. 3. Medical Attention: I hereby give my consent to GCHS to arrange transportation to a medical facility or onsite emergency medical services as warranted in the course of my child(ren)'s participation. 4. Waiver and Release: I am fully aware of and appreciate the risk of injury including the risk of catastrophic injury, paralysis, even death as well as other damages and losses associated with participation in athletic activities. I further agree that GCHS and its employees, agents, officers, volunteers and/or directors shall not be liable for any losses or damages occurring as a result of my child(ren)'s participation in the athletic program, except where such loss or damage is the result of intentional harm or reckless conduct of one of the organization or individuals identified above. As a legal parent or guardian of this/these athlete(s), I hereby verify, by placing my initials below, that I fully understand and accept each of the above conditions for permitting my child(ren) to participate in the GCHS sport(s) for which I have registered. In the event that I cannot be reached, I hereby give my consent to the attending physicians, trainers, and coaches to secure and/or administer emergency medical aid and obtain ambulance service if needed. At times, it may be necessary for the parents/guardians of student-athlete(s) to provide transportation for their child(ren) to/from athletic events or off-site practices. By placing my initials below, I state that I have read and understand that I accept full responsibility for the transportation of my student-athlete(s) to/from certain athletic events.

As the parent or legal guardian for the student(s) I am registering to participate in athletics at St. Theodore Guerin High School, I hereby consent to the student(s) receiving athletic training services from Franciscan Health Sports Medicine. I understand that during the course of these services, certain health information related to the athletic training services provided may be used and/or disclosed for treatment, payment or healthcare operations purposes, or as otherwise required by law. I further consent to certain health information being disclosed to school personnel, including but not limited to, the school nurse immediately, and as needed to coaches, school administration, and/or staff. I acknowledge the school nurse may make a follow up contact to determine what if any accommodations are required for school attendance and continued academic achievement. The school shall treat any records or documentation created for disclosure to school personnel as student records subject to the Federal Educational Rights and Privacy Act ("FERPA"). I understand this consent is subject to my revocation at any time, except to the extent that action has been taken in reliance on this consent. Otherwise, this consent shall expire at the end of the school year or my child(ren)'s current athletic season, whichever is later.

IC 20-34-7 and IC 20-34-8 require schools to distribute information sheets to inform and educate student athletes and their parents on the nature and risk of concussion, head injury and sudden cardiac arrest to student athletes, including the risks of continuing to play after concussion or head injury. These laws require that each year, before beginning practice for an interscholastic sport, a student athlete and the student athlete’s parents must be given an information sheet, and both must sign and return a form acknowledging receipt of the information to the student athlete’s coach. IC 20-34-7 states that an interscholastic student athlete, in grades 5-12, who is suspected of sustaining a concussion or head injury in a practice or game, shall be removed from play at the time of injury and may not return to play until the student athlete has received a written clearance from a licensed health care provider trained in the evaluation and management of concussions and head injuries, and at least twenty-four hours have passed since the injury occurred. IC 20-34-8 states that a student athlete who is suspected of experiencing symptoms of sudden cardiac arrest shall be removed from play and may not return to play until the coach has received verbal permission from a parent or legal guardian for the student athlete to return to play. Within twenty-four hours, this verbal permission must be replaced by a written statement from the parent or guardian. Parent/Guardian - please read the fact sheets available at the link at the top of the page regarding concussion and sudden cardiac arrest and ensure that your student athlete(s) has also received and read these fact sheets. As a parent or guardian of a student athlete(s) at Guerin Catholic High School, I acknowledge that our family has received and read the fact sheets regarding concussion and sudden cardiac arrest. I understand the nature and risk of concussion and head injury to student athletes, including the risks of continuing to play after concussion or head injury, and the symptoms of sudden cardiac arrest.