Timpview High School

Coaches ManualI .,<"""...

Timpview High SchoolAthletics & Extra-Curricular Activities2014

On behalf of the administration for Timpview High School, I'd like to welcome you as part of the Thunderbird family. Timpview's tradition of excellence is unprecedented. Since opening its doors in 1978 the athletic teams have won 79 State, and several state runner-up championships! The T-Birds haveearned many more region titles, several all-state winners, and academic all-state recipients.

Timpview currently is a member of Region 8 in the 4A classification along with Maple Mountain, Provo, Salem Hills, Spanish Fork, Springville, and Wasatch. As a member of the Utah High School Activities Association, the Thunderbirds participate in the following sports: Football, Girls and BoysCross Country, Girls and Boys Golf, Girls and Boys Soccer, Girls and Boys Tennis, Girls and BoysSwim, Girls and Boys Basketball, Girls and Boys Track and Field, and Volleyball, Wrestling, Softball, Baseball, and Drill.

UHSAA along with Provo School District require all coaches, paid or not to complete the following requirements prior to participating with the team and student athletes.

I) Physical Education Degree or Coaching Minor from any accredited institution or ASEPTraining provided by the district throughout the year (Free course) or completion of theFundamentals of Coaching course online at ww w .nfhslearn.com

2) Fingerprinted & background check. This can be done at the district office (by appointment).This is good for 5 years. Anyone with a current teaching license is cleared as well.

3) Current CPR/I" Aid certification. The district holds these free clinics throughout the year(free course) or the course can be taken through other means.

4) Concussion training is a Utah state law and must be completed online (free course) at ww w .nfhslearn.com

Upon completion of these requirements please inform the Athletic Director and the head coach of the sport. Inform yourself with all state protocol regarding eligibility, moratoriums, and your sport's regulations etc. at ww w .uhsaa.org . We at Timpview hold to the highest priority the ethics of athletics including all policies, procedures, and guidelines set forth by NFHS, UHSAA, Provo School District, and our own athletic department.

Welcome to Timpview High School athletics. This is a very deserving endeavor of mentoring and shaping the lives of adolescents. The athletic department's goals are the same as the schools- Personal responsibility, Respect, Integrity, Discipline, and Engagement. These attributes are what we want to instill within our student athletes during our time with them by "building responsible life-long learners who exemplify integrity and are prepared to meet life's challenges."

If you have any questions or concerns please feel free to contact me.

Thanks, Mike Hunter Athletic Director801-602-8624 mikeh@provo.edu

Acknowledgements

In putting together our athletic handbook and coach's manual, rd like to thank the many schools within the National Federation and Utah State High School Association that we used as models.

Auburn City School# I 0

Herriman High School-James Barnes AD

Hillsboro High School

Jordan High School-Marc Hunter AD

Josephson Institute of Ethics

Littleton School District

Provo School District

Timpview Athletic Trainer-Ben Ross

Timpview High School Athletic Website-Kirsten Bailey

Timpview High School Administration

Twin Rivers Unified School District

Upland High School

Utah High School Activities Association

U.S. Department of Health and Human Services-

CDC Washington County Public School System

Weston High School

A special thanks to Carole McElroy and Mary Poland for their technical assistance and editing of this handbook

Table of Contents

Section 1- Philosophy Timpview Mission Statement UHSAA Mission StatementProvo School District/Timpview OrganizationUtah Coaching StandardsAttributes/Qualities ofTimpview Coaches/AdvisorsJob Description, Responsibilities & Duties

Section 2- TravelProvo School District Policy Field Trip & Overnight Request Student Release FormEmployee Authorization to Transport StudentsUtah State Risk Management

Section 3- FinancialTimpview High School Financial handbook Provo School District Donation & Fundraising Expenditure Report FormQuotation & Sole Source Form Banner Policy & Form Approved School Fees

Section 4- Student AthleteOut of Boundary Student Orientation RegisterMyAhtlete (Guide for Parents) UHSAA EligibilityTryout Documents-

UHSAA Checklist, Transfer- Change of Residence/Hardship, Physical, Concussion, Sportsware, Code of conduct, Anti-Bullying&Hazing

Section 5- Evaluations & AssessmentsCoaching ChecklistPre season Parent/Athlete MeetingCoaching EvaluationCertification ReviewProgram SummaryAthlete & Parent Program EvaluationInventoryRegisterMyAthlete (Guide for Coaches) UHSAA Raise the Bar- Sportsmanship Academic All-State Nomination Accountability for Determining Eligibility

Timpview High SchoolAthletic Department Mission Statement

Timpview High School's athletic department believes that education based activities are a·privilege and enhances the well-being of those who fully engage in the process. The common core values associated with all programs are:

Personal ResponsibilityRespectIntegrityDisciplineEngagement

I fully understand the policies and procedures outlined in the Timpview High School coaches' manual. I also acknowledge the school's staff handbook and will .. follow its policies and procedures in regards to my responsibilities andemployment. I know that further training and information will be given throughout the school year on a regular basis and my obligation and responsibility to adhere and follow best practices as indicated is expected.

Name Date

Signature

UTAH HIGH SCHOOL ACTIVITIES ASSOCIATION

The purpose oftheUHSAA shall be to administer and supervise interscho lastic activitiesamongits member schools accordingto theAssociation Constitution and By-Laws.

Knowing that student activities are a significant educational force in thedevelopment of skills needed to become a contributing member of society, the UHSAA reaffirms that students are the focus and reason for the Association. As such, the Association will provide opportunities that:

Promote sportsmanship and safe competition through standardized eligibility rules.

Provide interscholastic sports, .nusic, drama, and speech. Create learning laboratories where practical life-situations,

teamwork, sportsmanshlp, winning and iosing, hardwork, leadership, and cooperation are taught.

Nurture self-realization and build self-confidence. Promote, through participation, higher academic

achievement, better attendance, lower drop-outrates, and positive citizenship.

199 East 7200 South, Midvale, Utah 84047 (801) 566-0681

Fax (801) 566-0633 www.uhsaa.org

All rights reserved. This book may not be reproduced in whole or in part, for commercial gain with permission. For information contact the Utah High School Activities Association.

Timpview Athletic DepartmentOrganizational Chart

Michelle KaufusiPresident- D2Julie RashVice President- D5

Steven Staples D1McKay Jensen D3

Shannon Poulsen D4Marsha Judkins D6

Jim Pettersson D7

SuperintendentKeith Rittel Dr.

Todd McKee

Chris Chilcoat

Mike Hunter CAA Kristen Bailey Asst AD Debbie Dodds Asst AD

Rob Cuff

KimMonkres Ryan Bishop Bart ThompsonJeff Cluff- Officials

Ben Ross Shauna Black

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Groups Roie & Requi r ed: R esponsibilities DISTRICT/BOARD <i;:j H 1J:Rll\1 1)1¥itlg

' ; sfilli'&0!1il Ship policies .. . .

ADMINISTRATION Establish and outline standards for sportsmanship rtdes • Provide adequate snpetVision at events' • Encouragesportsmanship

ATIU..ETIC DIRECTORS Implement a11d provide illfotnlatiou on sportsmanship roles • Eucoutage sportsmanship •Maintaill a positive environment at activities

COACHES Follow sportsrtumship stand!ttds • Demonstrate sporlsmanship rules • infotnl team of sportSmanship • Be ethie l•Estlihlish positive :relationships with officials

PLAYERS. Follow siJOrtsmanship .guidelines, Understand sporlsmanship tules, Cooperate wilh othets, :Oemotlstrate sporlsmansbip.

SCHOOL SPIRIT GROUPS Follow sporlsmanship guideJilles, Promote sporlsmltnship ill cheets, Deniollstrate sportsmanship qulltilies fot studellts itild :fulls.

...OFFICIALS l'ollow sporlsmllnship Rules, Contact Athletic

Admiliistrittors before cotltesT""at Administrators, ConcheS, J>layern !!rid fans with respect. .

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Attributes & Qualities of a Head CoachTimpview High

Persona/Integrity, Character and Positive Attitude• Demonstrates honesty in word and deed• Accepts responsibility for actions• Accepts blame and shares credit• Optimistic and positive in outlook• Avoids personal conflicts of interest• Models and expects fair play and good sportsmanship

Knowledge of the Game• Previous successful experience as a player and coach• Demonstrates an understanding of a variety of offensive and defensive structures• Demonstrates an understanding ofin-game adjustments• Demonstrates the ability to develop a team

A Teacher and Mentor• Previous successful teaching experience• Demonstrates an understanding of a variety of instructional methods• Demonstrates a greater concern for .the welfare of the studentthan his/her

own personal interest

A Strong Communicator• Rewards or praises excellence• Corrects mistakes through teaching• Demonstrates the ability to develop relationships with students• Demonstrates the ability to develop relationships with parents and the community• Demonstrates the ability to utilize a variety of communication methods

Organized and Detail Oriented• Sets personal and team goals/objectives and develops a plan to reach these

goals/objectives• Develops timelines• Demonstrates a commitment through hard work and initiative• Demonstrates the ability to see a task/project through to completion• Demonstrates the ability to appropriately manage funds and adhere to state rules,

district policies and school procedures.

Collaborator and Team Player• Demonstrates a willingness to be involved in the community• Seeks input from others• Supports the broader school goal of preparing students for college and career

Preyentatjye Measures

Before Event

I. Captain·s express appropriate behavior to model respect for opponents2. Learn the rules.3. Practice your coach's rules in character development.

During Event

1. Assist players who are down in getting to their feet.2. Never gesture to officials, players, coaches, or the fans in a negative or taunting manner.3. Never disagree openly with an official or coach's decision.Cany on ethically and maturely

regardless of your true feelings.4. Shake the opponent's hand ifhe/she fouls out, or extends congratulations when be/she is leaving

the contest.

After Event

1. Make every effort to extend a congratulatory handshake to your opponent immediately at the game's conclusion.

2. Never debate something that occurred during the game with anyone, as it is in the past.3. Be objective when communicating to the media about the contest. Don't be controlled by

your emotions.4. Show concern for injured opponents and teammates.5. Promote sportsmanship and your athletic experience positively whenever and wherever

the opportunity is available.

The Coaches

The UHSAA Code of Ethics for Athletic Coaches and Officials

Believing that my responsibility is an important part in the nationwide school athletic program,I pledge to act in accordance with these principles:

I. I will honor contracts regardless of possible inconvenience or financial loss.2. I will study the rules of the game, observe the work of the other coaches or officials and will, at

all times, attempt to improve the game and myself.3. I will conduct myself in such a way that attention is drawn not to me, but to the young people

playing the game.4. I will maintain my appearance in a manner befitting the dignity and importance of the game.5. I will cooperate with the news media in interpretation and clarification of rules and/or other areas

relating to good sportsmanship but I will not make statements concerning "calls"after a game.6. I will uphold and abide by all rules of the UHSAA and the National Federation.7. I will shape my character and conduct so as to be a worthy example to the young people who play

under my jurisdiction.8. I will give my complete cooperation to the school, which I serve,and to the UHSAA, which I

represent.9. I will cooperate and be professional in my association with other coaches or officials and will do

nothing to cause them public embarrassment.I 0. I will keep in mind that the game is more important than the wishes of any individual.

The coach must demonstrate and apply leadership, integrity, responsibility, self-control, knowledge of rules and regulations of the sport he/she is coaching, honesty and sportsmanship at all times on and off the playing field/court.It is necessary and important that the coach act in a responsible and professional manner at all times, because he/she represents the school, community, the profession, the faculty, and the student body. The coach must set a good example for those athletes he/she coaches.

Coaches must always keep in mind that essentially the game belongs to the players. The prim..,.,:·; justification for including the athletic program in the total school curriculum is based on the fact that athletics provide both physical and character values for those who participate in !hem. Student attain.men< of these values rests largely with the coaching profession.

Coaching is an extension of the educational process. It is necessary for players, coaches m,,.) officials to relate and "communicate" when there are concerns about a rule, a regulation, or any mntt.:·::'· concerning the welfare of all concerned. The coach must show respect, maintain proper bench e<•n(h;,.;·,· before, during, and after athletic contest, thereby assuring common courtesy and honesty when '""'" problem arises. The coach is probably the most influential person on the court/field and hislberwill reflect the actions of others.

Required Code of Ethics and Responsibilities

Inthe coaching profession, the primacy purpose of a code of ethics is to clarify and distinguish ethical and approved professional practices from those, which are detrimental and harmful. The ethics code and responsibilities, which follow, are required behaviors and as such are subject to sanctioning by Region Boards and the UHSAA Executive Committee.

Another purpose is to emphasize and confirm values of the athletic programs in schools across the nation.Applied to the coaching profession, ethics will help develop a standard of character in which the public has trust and confidence.The success of the principles and standards emphasized in the code is dependent upon those for whom they have been prepared -the coach.

A coach assumes certain obligations and responsibilities to the game, to the players, and to one's fellow coaches. It is essential that every member of the profession be constantly aware of these obligations and responsibilities so that the coaching profession will always remain an honorable one. Each member is to conduct him/herself in such a manner as to maintain the dignity and decency of the profession.

The coach should always be aware ofthe tremendous influence that he/she exertsfor good or bad. The coach should never place the value of victory above that of instilling the highest possible ideals and character traits in the players. The safety and welfare of the players should always be uppermost in one's mind and must never be sacrificed for personal prestige or glory.

Any attempts to teach unsportsmanlike conduct have no place in the coaching profession.Any coach guilty of such teaching, violates the basic purpose of high school athletics. The coach must set the example of winning without boasting and losing without bitterness.

It is important that the coach's conduct maintain the principles of integrity and dignity of the school, which employs him/her. School policies and the athletic program should be adhered to both in the letter and spirit.

A coach should assume that all members of the coaching profession intend to follow the precepts set forth in the code of ethics.All evidence of unethical conduct should be brought openly to the attention of the USHAA through prescribed channels. Sportswriters and sportscasters should not be used as an outlet for relieving iII feelings toward other coaches, players, officials or schools. ·

Therefore, as a professional educator, the coach must:

A. Exemplify the highest and moral character, behavior and leadership. B. Respect the integrity and personality of the individual athlete.C. Abide by the rules of the game in letter and spirit.D . Respect the integrity and judgment of sports officials, never baiting or taunting that official in

any way. The head coach is responsible for all bench personnel by rule.E. Demonstrate a mastery of and continuing interest in, coaching principles and techniques

through professional improvement.F. Encourage a respect for all athletics and the values they promote.

G • Display modesty in victory and graciousness in defeat.H • Promote ethical relationships among coaches.I. Fulfill responsibilities to provide health services and an environment :free of safety hazards. J. Encourage the highest standards of conduct and scholastic achievement among all athletes.K. Seek to·inculcate good health habits including the establishment of sound training rules. L. Strive to develop in each athlete the qualities of leadership, initiative, and good judgment.

General Responsibilities

1. Demonstrate sportsmanship at all times.2. Be responsible for the conduct of his/her players.3. Help in promoting good crowd decorum.4. Refrain the use of any profanity and/or physically abusive actions.5. Refrain from making any negative remarks to the news media.6. Have and show respect for the opponents;treat them as guests.7. Educate the student-athletes as to the rules and regulations of the game.8. Maintain proper conduct before, during, and after the athletic contest.9. Inform his/her team of the responsibilities contained in this document.

Preventative Measures

Before Event

1. Read and know the rulebook.2. An "open communication" network between coach and official must be maintained.3. Honesty is the best policy. Before each season, both coaches and officials must discuss

grievances and opinions, thereby presenting an exchange of ideas and recommendations.4. Officials could be invited to practice sessions to review any new rule changes and go over general

rules.On the court/field demonstration is very important.5. Discussion sessions with athletes lead by the coach and official are very important.

Sportsmanship, rules and regulations, respect must be the main focus of the agenda.6. The athlete must be made aware of his/her role and responsibility as a student athlete. He/She

must show respect and courtesy .toward officials and opponents. This may be done viateam/individual sessions with the coach.

7. Officials need to feel they are welcome when they enter the gymnasium. The athletic directo,· .·.-.·gym supervisor should greet and welcome officials.

During Event

1. Improper bench control or unsportsmanlike conduct in any sport is unacceptable.2. The athletes' demeanor and conduct is ultimately the coach's responsibility.3. It is important that the coach assist in maintaining good crowd orderliness.This is don0 ·;.· "'''·""

actions and/or mannerisms on the court/field. His/her actions may calm a crowd or exc.<·c· · ·4. Embarrassing an opponent by continued pressure defenses or premier players remainio; ''- '···

game to intentionally 11run up the score11 are one of the most unethical forms of coachl,::;;g; behavior.

5. Utilizing players, even if their names are legally in the scorebook, who are involved in simnltaneous game in a nearby facility to create an advantage to win a game is ethically unacceptable. It creates a travesty of the game.

After Event

I. Must never direct frustration over the outcome of the contest to officials, players or spectators.2. Develop good rapport with officials associations by attending local meetings or inviting official

association leadership to coaches meetings to interact in a positive and creative atmosphere.3. Should write a letter of commendation to the UHSAA when an official does an outstanding job of

officiating.4. Should refrain from making negative remarks to the·news media; if a problem arises, use the

UHSAA or Region Board to investigate issues.5. There will not be a meeting of officials and coaches after an athletic contest. Coaches must

respect the private are of officials at the conclusion of a contest.

The Players

The Role of the players in sportsmanship is second in importance only to the coach. Players are admired and respected by students of all levels as well as adults spectators. They have significant influence over the actions and behaviors of spectators of all ages.

Required Responsibilities

I. Accept and understand the seriousness of your responsibility, and the privilege of representing the school and community.

2. Learn the rules thoroughly and discuss them with parents, fans, fellow students, and younger students. This will assist both them and you in achievement of a better understanding and appreciation of the game.

3". Cooperate with the coaches and always exercise good sportsmanship by living the rules and rolesas stated.

· 4. Only the captain may communicate with the officials on the clarification of rules. It is his/her responsibility to communicate back to his/her teammates and/or coach.

5. Always respect the official's judgment and interpretation of the rules. Never argue or make nonverbal gestures, which indicate disagreement. This type of immature activity may inciteundesirable behavior in the stands ahd by teammates.

6. Congratulate opponents in a sincere manner following either victory or defeat. This is a true measure of character.

7. Exercise self-control at all times, accepting all decisions, unusual occurrences, and abiding by them.

8. Treat opponents with the respect that is accorded a guest or friend. Many lasting relationships may be developed from competitive situations.

9. Shake hands with opponents at an appropriate time wish them luck.

Head Varsity Coach Job Description

1. Serve as liaison between the coaching staff and the Athletic Director.2. Have a thorough knowledge of the rules and by-laws of the Utah High School Activities

Association, the Region and the Provo School District that pertain to his/her sport, including the background clearance of all staff members and student-athletes.

3. Understands the proper administrative chain of command and refers all requests or grievances through proper channels. Is aware of all public/staff/departmental meetings that require attendance.

4. Establishes the fundamental philosophy, skills and techniques tobe taught by the staff.Designs conferences, clinics and staff meetings to ensure staff awareness of the overall program.

5. Trains and informs staff and encourages professional growth by promoting clinicattendance.

6. Delegates specific duties, supervises implementation, and at season's end analyzes staff effectiveness and evaluates all assistants.

7. Maintains discipline, mediates grievances, and works to increase morale.8 . Assists the Athletic Director in scheduling, providing transportation needs

and requirements for all games, tournaments, and special sports events.9. Assists in the necessary preparation for scheduled home sports contests or practices

and adheres to scheduled facility, usage times.10. Coordinates facility needs/repairs with maintenance and school employees.II. Provides proper safeguards for eminence and protection of assigned equipment12. Recommends policy, method or procedural changes to the Athletic Director.13. Monitors the grades and conduct of his/her athletes.14. Provides assistance, guidance, and safeguards for each participant by his/her presence at

all practices, games, while traveling, and when returning from off-campus events.15. Completes paperwork in all disabling athletic injuries on proper forms and submits to the

Athletic Director by the next school day.16. Directs student managers, assistants and statisticians.17. Determines discipline, delineates procedures concerning due process when the

enforcements of discipline is necessary, and contacts parents when a student is suspended, dropped or becomes ineligible.

18. Participates in the budgeting process with the Athletic Director by submitting needs for the next season.

19. Recommends/selects equipment and uniforms within budget appropriations.20. Is accountable for all equipment in his/her program and submits notification to the

Athletic Director for any equipment lost, damaged not returned or returned after the due date.

21. Arranges for issuing, storing, reconditioning of equipment, and submits annual inventory.22. Properly marks and identifies equipment before and after practice.23. Secures all doors, lights, windows and locks and stores all equipment before leaving

building or area. Supervises locker room area before and after practice.24. Instills in each player a respect for equipment, school property, and their proper use.25. Responsible for maintairing good public relations with news media, parents, officials,

volunteers and fans.

26. Responsible for reporting scores and information after every home contest to the local newspapers. Statistics required by local media, league representatives and Max Preps would also be the responsibility of the head coach. These duties may be delegated.

27. Head coaches in football are responsible for having written contracts for non-league games with opposing schools.

28. Responsible for arranging with the Principal's secretary for substitutes needed because of athletic events. The Athletic director may be contacted in an emergency.

29. Understands that all drivers must meet district requirements to transport student-athletesand must be at least 21 years of age.

30. Guarantees that all district equipment including district vehicles are used for official school business only and are operated safely.

31. Performs other duties which may be assigned by the Athletic Director.

Assistant Coach Job Description

1. Have a thorough knowledge ofthe rules and by-laws of the Utah High School Activities Association, the Region, and the Provo School Districts that pertains to his/her sport, including the clearance of all staff members and student-athletes

2. Understands the proper administrative chain of command and refers all requests or grievancesthrough proper channels.Is aware of all public/staff/departmental meetings that require attendance.

3. Maintains discipline and works to increase morale and cooperation within the school sportsprogram.

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4.

5.6.7.

8.

9.

10.11.12.13.

14.15.

Assists in the necessary preparation to hold scheduled sports events or practices and adheres to scheduled facility usage times.Coordinates facility needs/repairs with maintenances and school employees. Provides'proper safeguards for maintenance and protection of assigned equipment.Provides assistance, guidance and safeguards for each participant by being present at all of his/her practices, games, while traveling and when returning from off-campus events.Is accountable to the Head Varsity Coach for all equipment. Assists with issuing and collecting of equipment and submits an annual inventory to the Head Varsity Coach.Recommends to the Head Varsity Coach budgetary items for the following year in his/her area ofthe program.Secures all doors, lights, windows and locks, and stores all equipment before leaving areas. Instills in each player a respect for equipment, school property, and their proper use.Assists the Head Varsity Coach in carrying out his/her responsibilities.Instructs team members as to changes in the rules and teaches fundamentals ofthe sport as outlined by the Head Coach.Works within the basic framework and philosophy of the Head Varsity Coach of the sport.Attends all staff meetings and carries out scouting assignments as outlined by the Head VarsityCoach.

16. Never criticizes, admonishes or argues with the Head Varsity Coach or any staff member within ears and eyes of players or parents.

17. Strives to improve skills by attending clinics and using resources made available by the HeadVarsity Coach.

18. Responsible for arranging with Principal's secretary for substitutes needed because of athletic events. The Athletic Director may be contacted in an emergency.

19. Understands that drivers must meet district requirements to transport student-athletes and must be at least 21 years of age.

20. Guarantees that all district equipment including vehicles are used only for official school business and are operated safely.

21. Performs other duties that are consistent with the nature of the positions and that may be requested by the Head Varsity Coach.

Timpview High School Athletic DepartmentCoaches Information Card

Sport(s) you currently c<:>:a.ch-----------------------Nrune

Cell Phone-------------------

Ad ess

City--------------State-----------Zip----------------

Your Coaching Position Head Assistant

Specific Duties or Level _

Do you have the 5 elements for coaching areas current?

1. Background Check Yes No When

2. Concussion Training Yes No When

3. First Aide Training Yes No When

4. CPR Training Yes No When

5. Coaches Certification Training Yes No When

6. Your Teaching Degree areas:(List all Majors)

Responsibilities

SCHEDULING

Buses- Bus requests need to be turned in 2 week in advance to an event. (A $30 fine will be imposed if scheduled after 2 weeks) Your program may also be fined if you do not cancel within 24 hours.

Games -You are responsible to schedule any preseason games/tournaments. A regional coaches meeting will be held around mid January to give you the region handbook/schedules and policies. DO NOT MISS THIS MEETING! Check your handbook to see how many games you can have so you don't schedule too many games. When you have completed your schedule give a copy to AI Poland to schedule officials,Ben Ross for training purposes and Kristen Bailey for scheduling.

Scheduling- All scheduling needs to be done through Clay Bingham. Check the calendar for availability. https://www.google.com/calendar/b/0/embed?src=Iimpview.calendar@gmail.com Once your event is approved it will be added to the calendar. The event facility request form is found in appendix

Scheduling includes, camps, open gym, games and practice. Let's make sure we get everything on the calendar to avoid scheduling conflicts. In season sports will always have first priority.

Camps- If you choose to do a camp, please schedule it with Clay Bingham. Any questions regarding district/school policy see Chris Chilcoat.

Weight room-schedule with Kristen Bailey.

Fundraising -you can choose your fund-raiser. However you will need to get it approved by an administrator. Fundraiser Proposal Sheet are available.

Calling in scores after games (home teams are required to tum in scores.) You will have angry parents if you do not call in the scores. Be prepared to give scores, stats and a statement)

Daily Herald 801-344-2550• Deseret News 801-237-2161

Salt Lake Tribune 801-257-8900

Academic All-state- Academic All-Stat e is for seniors who have a 3.75 GPA or better. They will not accept late applicants. Applications are submitted online.

First Aid/CPR certification-All coaches are required to be certified in both first aid and CPR. Classes are available through the district. Once you have your card, make a copy and give to the Athletic Director.

Concussion Training-Coaches are also required to complete a "Sports Concussions ManagementPlan".

Rules clinic-Every sport has a rules clinic they are required to either attend or take on line. More information is on www.uhsaa.org. If you miss the deadline the state will fine your program.

Parents Meetings and Year end Banquets-Schedule with Clay and invite the administrators to attend.

Senior Night-Kim Davidson will order your seniors flowers on senior night. Give her the names of yoursenior a week in advance.

Excuse lists-If your athletes are going to miss school or need to be excused from class early, you need toemail an excuse list two days in advance to Debi Hutchings in the attendance office.

Hiring Coaches·Coaches need to have and pass a background check from the district before they can coach. Paperwork for hiring coaches can be picked up from Michelle in the front office. Do not wait to get their paperwork done.

**Money Box- If you need a money box, first get approval from the administration (forms completed), then see Shuana in the financial office.

Event workers- Those helping out at the games will be coordinated prior to the events and job description will be available. Compensation is $35 per event. Job include tickets, supervision, announcer, scorekeeping etc.

Lockers- Each team has a designated area when in season. Communicate with Cary or Kristen if locks are needed.

Websites are optional but very beneficial for parents, athletes and recruiters. Check out football and volleyballs web sites to get ideas.

Travel

District Travel Policies

The Following Forms need to be filled out for transporting students.

Bus Request Forms -Need to be filled out two weeks before travel. PIe as e submit requests toChris Chilcoat.

Out of State or In State Overnight Stay - Request for Student Travel - This form needs to be filled out and approved by.the school board. The'board meets twice each year.

Coaches or parents transporting Students- Employee Authorization to Transport Students -Parents or coaches planning on transporting students also need to pass the Division of Risk Management Driving Test. After the test has been completed drivers will need -to tum in the following:.

Certificate of Completion from Risk ManagementCopy of Drivers LicenseCopy of Insurance Card

Students driving with coach or parents other than their own - Student Release Form

Road Trips

DO NOT PUT AN ATJU.ETE IN ANY OTHER VECIDCLE BESIDES THE BUS WITHOUT FOLLOWING THESE STEPS! YOUR JOB IS AT STAKE! On road trips athletes can only be released to their guardians, not .aunts, uncles, friends, boyfriends girlfriends etc.Upon arrival from your road trip, do not leave Timpview until all athletes have been picked up. You are still responsible for them until they are offTimpview grounds.

Ordering a bus

Go to:1 - https:llinfofinderle.transfinder.com/provo.edu/login.aspx?DB=62 - lnfoFinder LE3- Login: Email login name -Ex: toddm4- Password: 12345 - Request a Field Trip (right hand side of webpage under Quick Links6 - Field Trip Name : Type in Sport/Activity to the school or location - Ex. JV Football to Spanish Fork7 -All red stars need to be completed before submission8- Include Cell # under PHONE8- Invoice Information: Select School Check- GTE needs Account# fromKathy Firmage9- If you have special requests, they must be written in the Notes section.10- Questions: please call Chris Chilcoat- (801) 960-7347

Provo City School DistrictPolicy Series 4000: Curriculum, Instruction, Assessment

Policy No. 4006

Student Travel: Field Trips & Overnight Trips

The Provo City School District Board of Education recognizes that experiences beyond the classroom may provide meaningful enrichment for learning. The Board expects that as a foundational purpose, all such experiences - defined as a form of an authorized field trip - will have clear connections with the related curricular/co-curricular program. Such connections must have meaningful, relevant and defensible justifications to support missed class time,cost, etc. While student travel may include activities that are not part of the approved curriculum, it is understood that the general purpose of student travel is to supplement regular school educational programs.

Student Travel is defined in the following manner: I) Non-Overnight field trips.2) Overnight field trips of less than 270 miles distance from Provo and in-state.3) Overnight field trips of more than 270 miles distance from Provo, out of state.

The Board directs the superintendent to develop procedures for each of the Field Trip categories noted above to include:

I) Approval processes,2) Non-commercial sponsorship,3) Justifications for travel,4) Limitations on the number of overnight trips per group per school year,5) Risk Management Approval and Insurance6) Adherence to Deadlines for requests/approvals7) Chaperoning and Supervision of Students8) Emergencies, Accidents, and Student Discipline9) Trip organization and PlanningI 0) Costs and per-student charges, including chaperone expenses11) Fee waivers12) Fund-raising13) Travel Safety14) Transportation and Travel Arrangements15) Travel conditions, including national and international issues

To have a better chance of receiving approval, all travel arrangements must adhere to the procedures developed to accompany and implement this policy. In accordance with recent state guidance, the designated State Travel -contracted agency service must be used for all overnight trips.

The Board is concerned about the financial demands placed upon families with a child/children wishing to participate in student travel events. All school sponsored activities are eligible for fee waivers for low income students, with the overall costs still needing to be met for the trip. Traditionally, the impact of fee waivers would be covered in any combination of the following: fund-raising, donations, levying additional costs on non-fee waiver students, and/or the costs would be absorbed by a school budget.

In an effort to protect overall financial impacts on families regarding student travel-along with all other impacts and concerns for travel - the board reserves the right to limit costs, distances, etc. of requested student travel. In so doing, the board may deny travel requests that would have excessive cost, undue loss of instructional time, minimal education value, and/or other characteristic(s) that the board would deem to result in an unworthy travel event.

The Board may be willing to approve international and/or longer trips under certain conditions, such as a trip by a curriculum-related language club to a related country. Such trip requests will be reviewed on an individual basis and considered on their own educational merits, but similar trip requests will not be approved for consecutive years."

Non-School District (private) trips such as "senior parties" or "graduation" trips that take place after high school graduation or trips sponsored by staff or parent groups outside of the regular school calendar are not approved, sponsored, or otherwise endorsed by the School District. These trips are private, and/or commercial ventures and are not District "field : There is no approval process since these are not school-sponsored trips, but the build' '[:'principal must be notified, prior to any trip promotion by a staff member, of any indepr '"k '· private trip organized by a staff member and involving school district students. Scho<ol communication systems, supplies, or equipment may not be used for the planning, p;,,.• ,:or conduct of such trips.

'. cgal References: Synopsis

: .'tah Code 53A-12-103:Jtah Administrative Code Rule R277-407Utah Administrative Code Rule R277-515i.ilah Administrative Code Rule R277-600

Waiver of FeesSchool FeesUtah Educator StandardsStudent Transportation Standards & Fe<>·.' .,.,;;,,...

i\ ppwved by Board of Education: March 12, 2013

.'',. :- P:..-:_, .:-' 4006 Student Travel

Provo City School DistrictPolicy Series 4000: Curriculum, Instruction, Assessment

Student Travel: Field Trips and Overnight Trips4006 PI

Field Trips and Overnight Trips are subject to the criteria of' possessing a clear educational purpose per language in Policy 4006. Student Travel will not be approved if it is seen to be more of a vacation than an educationally defensible experience. Extended excursions should not be requested if comparable experiences are available closer to home. Students are not to remain overnight if it is practical to return home.

This procedure delineates all aspects related to student travel. Principals, teachers, coaches and other district staff intending to conduct Field Trips and/or Overnight Trips are required to follow all aspects of this procedure.

Trip TypesThree general categories of Field Trips/Overnight Trips may occur under Provo City SchoolDistrict oversight:

"Non-Overnight Field Trips" are approved at the school level by the building principal.

"Overnight Field Trips ofless than 270 miles from Provo and within the state of Utah"are approved by the superintendent and are to be submitted not later than three (3) weeks prior to the proposed event. Further criteria for approval of this type of overnight field trip are a) per-student costs of< $500, and b) no more than 2 school days missed.

"Overnight field trips of more.than 270 miles from Provo and out-of state" are approved by the PCSD Board of Education twice yearly, without exception. Approvals occur in the September and February business meetings of the Board. All applications must be submitted for Board review not later than two weeks prior to the respective board meeting. The Board will consider trip applications in this category that exceed the criteria noted in the two previously listed types of trips.

I. Approval ProcessesThe Board of Education respects the right of parents to take their own children to competitions or performances that are not approved by the Board or its designee. However, non-approved activities are not considered activities of Provo City School District and the district assumes no liability for these events. The use of the name or moniker of the district or its schools in fund raising, or in identifying supervisors who are district employees, is forbidden. All otheractivities or actions that imply district support of these events are also forbidden.

No student will be subjected to undue pressure to participate in school-sponsored travel activities. Non-participation in student travel may not result in loss of credit, reduction of grade, removal from a team or any other negative consequence to students.

Though a final number of students participating in an upcoming travel and /or field trip may not be exact, travel requests needing approval from the Superintendent or Board of Education must be submitted well in advance of the proposed excursion.

Parent ApprovalParents/guardians must provide written consent for all travel. A parent/guardian consent form may be signed at the beginning of each school year giving permission for students to participate in all regularly scheduled local field trips. Overnight trips require a separate consent from that is specific to the particular trip. Overnight trip consent forms must include the nature of all of the activities in which the student will participate. They must also include permission to participate signature Iine(s), emergency contact telephone numbers, and permission to provide emergency medical care. All such documentation must be in hand not later than 24 hours prior to departure. The staff sponsor is required to take a copy of all such documents with him/her on the trip. A copy of this same documentation must be left at the school.

Principal ApprovalWhile some travel requests receive final approval by the Superintendent and/or Board of Education, all travel must first be approved and recommended by the principal after safety, supervision and educational justification have been verified.

When the principal is forwarding applications on to the superintendent and the board for approval, all criteria on the form must be clearly and defensibly addressed, and all appropriate signatures are to be in place. The application forms being approved are considered to be binding in that no material variation of the approved plans will be permitted. "Material variation" is defined as no increase in cost per student, no levying of additional fees, no additional days of school missed, etc.

The principal and event sponsor must also be prepared to address concerns around testing schedules and fee waivers, in addition to all other aspects of this procedure.

II. Non-Commercial SponsorshipSchool employees are not to solicit students to participate in any commercial or non-school sponsored trip or excursion. District approved and sponsored trips will not occur through for profit agencies.

III. Justifications for TravelThe study of curriculum at the school site provides the basis for student learning in Provo City School District. However, meaningful activities and field trips can enhance the learning and experience for students and are supported by the Board and district administration. To be considered for approval, an activity or field trip must meet the following criteria:

• Has a high degree of educational value and serves a definite educational purpose• Enhances the quality of students' educational experience and does not disrupt the

basic educational program• Originates from a current unit of study and is appropriate for the age and maturity

level of the group

2!Page 4006 PI Stude11t Travel: Field Trips and Overnigllt Trips

• Provides understanding to students of the purpose of the trip and the expected learning outcomes

• Assures student safety and meets requirements for appropriate liability insurance

Extra-curricular Trips include travel by such groups as academic teams, athletic teams, performance teams, and other school recognized groups to recognized UHSAA meets, workshops, or other forms of state and national competition that enhance the participants' skills and performance. These trips must also meet the criteria detailed above.

Overnight travel for elementary and middle school students is not part of these educational programs and can only be approved by the Board of Education. An exception may be granted to an individual student or group that wins a competition supported by the district and qualifies for state or national competition. Fifth Grade Camp would be another notable exception.

IV. Limitations on the number of overnight trips per group per school year.No high school group may participate in more than two overnight trips during any school year, nor miss more than two school days on any one trip. This applies to school groups, not to individual students who are participant in approved overnight travel with multiple school groups. Overnight trips for elementary and middle school students are discouraged but may be allowed with the permission of the Board of Education.

The two-day limit is waived for overnight trips emanating from qualification in national academic competitions, namely, DECA, FBLA, FCCLA, FFA, VICA, HOSA, TSA, Central Utah Science and Engineering Fair. The Superintendent must approve this travel.

V. Risk Management Approval and InsurancePart of the approval process includes that requirement that all PCSD-sponsored trips are subject to review by the Utah State Risk Management agency. If Risk Management recommends that a proposed travel event (or portion thereof) does not meet appropriate standards, the trip will not be approved and/or the portion of the trip must be adjusted.

Following trip approval, Utah State Risk Management services will provide Provo City School District with liability insurance. However, as part of the approval process the Board or Superintendent may require additional risk insurance to protect the financial status of the district and to help families cover expenses should an accident occur. A detailed itinerary must be submitted for Utah State Risk Management approval. Once approved, the itinerary cannot be changed.

VI. · Adherence to Deadlines for Trip Approvals.Advance principal approval for Non-Overnight Field Trips may occur on an as-needed timetable that works for the school, taking into consideration the requirements of making travel arrangements and providing ample notification to parents.

Advance superintendent approval for Overnight field trips of less than 270 miles from Provo and within the state of Utah requires that all request forms and accompanying documentation be

31Page 4006 PI Studeut Travel: Field Trips and Ovenligllt Trips

submitted to the superintendent's office not later than three (3) weeks prior to the proposed event.

Advance Board of Education approval Overnight field trips of more than 270 miles from Provo and out-of state takes place at the Board's business meetings twice each school year; in September and February. Trip sponsors must plan well in advance to obtain Board approval, and must submit all related documentation to the superintendent's office not less than three weeks prior to the meeting where the application will be considered. No other provisions are available for Board- approved Student Travel outside of the September and February board meetings.

It is a violation of this Policy and Procedure to conduct any form of Student Travel without having advance approval and without following all applicable aspects of these procedures.

VII. Chaperoning and Supervision of StudentsWhenever students travel, there shall be adequate and mature supervision to provide for the safety of the students.

Students should never be left behind and or unsupervised while under the custody of the district.

Trip sponsors will provide (and principals will ensure) enough supervision to assure the safety ofstudents. While this supervision will vary across activities, the minimum supervision allowed will be one (I) chaperone to ten (10) students.

If both male and female students will be attending the overnight trip, both male and female chaperones are required.

Care should be exercised in selecting adult supervisors. All trip chaperones are, by definition, volunteers and therefore must pass a fingerprint/background check. They should be persons of good report, a minimum of21 years of age, preferably older. Chaperones should be the parents or teachers of the participating students. Other supervisors (if used) must be prior approved by the principal. Older siblings of student participants in the trip are discouraged. Supervisors may not share private sleeping rooms, such as motel rooms, with students other than their own children.

VIII. Emergencies, Accidents, and Student DisciplineIn case of an emergency occurring during the trip the chaperone is authorized to make those adjustments necessary to insure the safety and well-being of the students and will immediately report the emergency to the principal of the school. All circumstances related to any accident will be documented and reported in writing to the district business administrator (risk management officer).

Academic and behavior standards shall be established prior to trip approval by the principal and published by the teacher on the approval form. Participants in any travel experience should be students in good academic and behavioral standing and approved for travel as per the published standards for the trip and outlined in this policy. Students who travel under the name of the school and adults who supervise that travel become role models for others and help establish and

41Page 4006 Pi Student Travel: Field Trips and Overnight Trips

maintain the reputation of the school and district. Behavior and conduct of students and chaperones fall under the rules and policies for the school, district and State Code (Reference: Utah Code 53A-11-908), in addition to the specific standards adopted for the event. Members of the travel group who violate the behavior expectations outlined will be sent home from the travel experience and will travel home at their own expense.

IX. Trip Organization and PlanningExtended excursion planning should be started as far as possible in advance of the trip to permit adequate time for students to earn the necessary funds. Representative students and parents should be involved in all phases of trip planning. A parent information meeting is required for overnight travel. The school must provide evidence of substantial support by members of the group and their parents prior to principal approval.

Trip sponsors are required to develop complete itineraries, including daily 24-hour plans and activity listings. Also included in the documentation will be room assignments, code of conduct expectations, curfew requirements, and buddy groups. Assuming students will be bringing cell phones on the trip, a complete list of student and chaperone cell phone numbers will be compiled and available for chaperone use.

As noted in section XV below, all travel arrangements are required to go through the contractedUtah state travel agency.

X. Costs and per-student charges, including chaperone expensesThe cost of travel shall be kept as low as reasonably possible without compromising the safety of the students and chaperones involved. No student at any grade level shall be denied participation due to lack of funds if the excursion takes place during the school day. For more extended student travel, students will be encouraged to participate in approved fund-raising projects.Trips sponsors are discouraged from levying an amount per student to cover chaperone costs.

Trip sponsors may be concerned about needing some funds while on the trip. If so, they must make arrangements to access funds in advance of the trip. All receipts and unused funds must be returned to the school finance secretary immediately after the conclusion of the trip. The Provo City School District finance office will provide assistance to the designated school travel contact person in dealing with use of p-card and/or cash advances, and financial reconciliations related to each trip. All such records are subject to audit.

The school will designate a travel contact person who will coordinate travel arrangements per the directions in this policy and procedure. That individual will handle all trip arrangements and wi!I coordinate with the Provo City School District purchasing office.

XI. Fee WaiversAll PCSO-approved trips are required by law to be eligible to all students regardless of a student's ability to pay for the trip. Trip sponsors cannot deny students participation in the trip due to an inability of the student to meet the cost. For this reason, all trips should be designed to incur as little cost to students as possible. Per state law fee waiver students may be required to participate in fund raising activities.

SIPage 4006 PI Student Travel: Field Trips and Overnight Trips

XII. Fund-raisingAll approved fundraising will be in accordance with district fundraising policy and procedure.

Fundraising conducted to provide funds for student travel must be approved by the principal Individual students may not be assessed amounts to fundraise. However, general fundraisers may be held.

XIII. Travel SafetyThe safety of participants is of primary concern when travel occurs. Schools are to provide clear safety instructions to students and chaperones prior to leaving for a travel experience and review safety instructions periodically during extended travel experiences. Travel planning should include consideration of weather conditions and provide for cancellation or extended travel time in the case of inclement weather conditions. Except when taking school buses, all passengers will wear seat belts while traveling under the approval of Provo City School District or its designees.

XIV. Transportation and Travel ArrangementsUnder no conditions is travel approved with student drivers. Students are never approved to drive other students to, from or during school-sponsored events.

Elementary school travel ten or more miles from the school requires use of a district bus or licensed public carrier. However, the student may travel with his/her own parent. Elementary school travel less than ten miles from the school may be provided by staff and parents who are willing to assume all legal liability associated with personal transportation, and have competed the online risk management driver video training and test.

Secondary school travel requires the use of a district bus or licensed public carrier. However, the student may travel with his/her own parent. With approval from the principal (day trips) or superintendent (overnight trips), chaperones may transcript small groups of secondary students in private, rental, or district-owned vehicles. Secondary school travel less than ten miles from the school may be provided by staff and parents who are willing to assume all legal liability associated with personal transportation, and have completed the online risk management course.

All student travel arrangements must be booked through the contracted Utah state travel agency and in accordance with state travel regulations. No arrangements with other travel agents, including those who have a connection with the school/program/trip sponsor are authorized.

All drivers of private vehicles must sign the Provo City School District Authorization to Transport Students Form (insert Form# here), providing evidence of a current driver's license and automobile insurance that meets the state minimum liability requirements, and completion of)tate Risk Management online training. All drivers of rental vehicles must obtain insurancehrough the rental company. All trips shall be planned to minimize danger through wise choice

:>freads and decreased speeds.

·!Page 4006 PI Studelli Travel: Field Trips a11d Overuig!Jt Trips

No student of any age should travel anywhere alone with a staff member or parent, other than his or her own parent.

Extended travel should not be initiated after I 0:00pm and should end prior to midnight, unless it takes place on a commercial carrier.

XV. Travel ConditionsTravel shall not be approved if unsafe conditions exist. If unsafe conditions arise after-travel has been approved, travel shall be cancelled or changed accordingly. Prior to departure on a trip, the Principal Superintendent and/or Board reserves the right to conduct a safety review of the trip and to cancel the trip if conditions warrant such action. Unsafe conditions include, but are notlimited to adverse weather conditions, outbreaks of serious, communicable diseases and actual orthreatened violence or terrorism. If relevant, US State Department Travel Warnings will be taken into account: if a country/destination appears on the Travel Waming list, the trip will be denied and/or cancelled. Should a trip be cancelled due to safety concerns, the school and/or district will not reimburse travelers for unrecoverable lost fees. Therefore, the districtencourages travelers to secure cancellation insurance (at their own expense) to provide protection against possible trip cancellation.

Foreign travel will generally not be considered except for groups associated with foreign language classes (i.e., German, French, Spanish, etc.) and then only for students who have · successfully completed academic work in the content area.

XVI. ConclusionWhile the district administration and Board of Education recognize the educational value of off campus experiences, it should not be assumed that making application for travel approval means the travel will always be approved. The Board and Superintendent expect that any application for extended travel has sound educational justification and meets the high expectations of the district for student safety and financial equity;

Applications for extended 'travel are more likely to gain travel approval if: I. There is high educational value.2. The cost per student is not excessive3. Minimal school time is missed.4. There are not'equivalent opportunities that are closer and less expensive.5. Safety concerns have been met and cleared.6. Adequate insurance is built into the plan.7. Sufficient student and parent support exists to make the trip a viable education experience

and worth the expense.8. Advance planning is such that adequate time and methods exist to earn money for the trip.9. Fee-waiver students have the opportunity to participate in the trip and the school has

adequate resources to cover the fee waivers.10. No pressure is placed on non-participating students who are members of the group.II. The group has been reasonable in its previous travel requests (location and cost) and has had

success in previous travel (i.e., no problems).

71Page 4006 PI Student Travel: Field Trips anll Overnight Trips

12. Students will be able to meet established and required school, state, and/or national testing schedules.

Non-School District Trip Guidelines

Non-School District trips such as "senior parties" or "graduation trips" that take place after high school graduations or trips sponsored by staff or parent groups outside of the regular school calendar are not approved, sponsored or otherwise endorsed by the District. These trips are private, and/or commercial ventures. The District does not pay wages or any other trip-related expenses for any staff member to supervise the trip and the District has no control over organization of the trip. Such activities are not District "field trips."

Any staff member and/or parent group/organization conducting a non-District sponsored trip should state prominently on all correspondence and communications regarding the trip that:

I. The trip is not a School District field trip and that the Provo City School District accepts no liability for the trip. Neither the name Provo City School District, nor the name of the school (except to identify the specific parent group sponsor), shall be used in correspondence or communications regarding the trip.

2. The District is not responsible for any information, claims or representations promulgated to students and/or parents regarding the trip.

3. The name of the parent group/organization sponsoring the trip must be clearly noted on all correspondence and communications.

4. School uniforms are not permitted to be worn for non-district sponsored activities.5. Staff participating in a non-sponsored trip shall be responsible for assuring the following:

a. All handling of student money/funds will be by the sponsoring organization and collected outside of the instructional day, including lunch periods.

b. There shall be no participation in a trip during regularly scheduled school/work days. c. Review the liability coverage of the sponsoring organization and consult with personal

insurance company for additional coverage. The District's liability insurance does not cover any participants, including students, staff or parents on any non-sponsored event.

d. Contracts/agreements are not to be signed by anyone acting as a representative of ProvoCity School District.

e. District employees will receive no compensation or expense reimbursements from the district.

f. Use of school facilities for planning meetings shall be in compliance with District facility use procedures.

g. Use of District equipment and other resources is limited to musical instruments, sheet music, uniforms, costumes and other ancillary performance items that may be checked out by teachers/students/parents.

h. Student participation must be voluntary and staff must avoid any actions that mightotherwise appear to recommend or promote participation in the trip as related to the educational program.

Approval Date: May I, 2013

BIPage 4006 PI Student Travel: Field Trips and Overnight Trips

PSD Student Travel Policy DraftRevised 7/9/03Board Approved Amendments April 12, 2005

Provo School DistrictRequest for Student Travel

Requiring the Endorsement of the Superintendent and/or Board of Education

Educators submitting this request should first read the Provo School District Procedures and Policy Related to Student Travel and Field Trips. This form must be submitted at least two months in advance of the planned travel.

Indicate the travel category for which approval is requested:

D Athletic competition in excess of !50 miles (one-way)D In-State of one-night stay or moreD Out-of-StateD Trip requiring a per-student cost of $500 or moreD Foreign travelD Trip Requiring more than two days out of schoolD Other _

School

Teacher(s) Leading Trip·-------------------------------- -

Group

Event

Destination

Dates of Travel Days of School Missed _

How many other overnight trips has the group taken this year? _

This request will not be considered for approval or advancement without complete answers to the questions below:

Educational Justification: What are the educational objectives of the trip? Can these objectives be replicated with closer, less expensive travel?

--------------------------------------------------------------------------------·I

Approved October 14, 2003Board Approved Amendments March 9, 2004Board Approved Amendments Apri/12, 2005

Standards for Participants: What are the academic and behavioral standards that must he met by participating students?

.--------------------------------------------------------------------------'

Safety:L' --------------------------------------------------------------------------In what ways will you insure the safety of students while traveling or participating in activities? (Describe special instructions to students, supervision guidelines to chaperones, etc.).

Where will students he staying at night?.' ---------------------------------------------------------------------------

'·

' '--------------------------------------------------------------------------Number of Students Traveling _

Number of Adult Chaperones (a student must have a chaperone of the same gender)

Date of Parent Meeting (Required for Overnight Travel)

Method of Travel: (Check all that apply)D School BusD Charter BusD Parent Transporting Own ChildrenD Chaperone Transporting Children

· D Airline (Disclose ground transportation plans: _ l.D Other (Specify). _

Participation by Student is: D Optional DMandatory

If overnight travel, have parents signed consent forms?DYes D No, but they will prior travel

2

Approved October 14, 2003Board Approved Amendments March 9, 2004Board Approved Amendments April 12, 2005

Financial: As a school sponsored activity, fee waivers apply. How will you cover the potential costs of fee waivers?------------------ ---------------------------------------------------------------

••··---------------------------------------------------------------------------------How much must a student pay or fund raise to participate? _

Total cost of trip per student (if other funds used): _

I have read the Provo School District Policy and Procedures Related to Student Travel and Field Trips and understand I am responsible for the safety and well being of students while on the proposed excursion.

(Signature of Group Leader) (must be PSD employee)

(Date)

have reviewed the itinerary of the proposed trip and reviewed safety procedures with the supervising educator. I have confirmed that no student will be penalized in any way if he/she;·.annot participate in this travel experience. I recommend this travel to the Superintendent.

(Signature of Principal) (Date)

!proval of Superintendent

(Superintendent) (Date)

..,•cial Conditions Related to Superintendent or Board Approval:

3

Approved October 14, 2003Board Approved Amendments March 9, 2004Board Approved Amendments April 12, 2005

Provo School DistrictRelease Form

Student Name

Parent Name

Address

City/Zip

Phone Number Day Evening Cell

Parent Medical Insurance Company

Insurance Policy Number

Please list any health issues or medications being taken that the activity advisor should be aware of. (If so, please give instructions.)

(Name of Activity) (Dates of Activity)

This is to certify that my student has permission to attend the above named activity. In the unlikely event that my student becomes ill or is injured, I authorize the advisor(s) of this activity to act as my agent to secure the services of a physician, dentist or hospital and to incur the expenses for necessary services. I will provide for payment of these costs. (The activity advisor will contact the parent or guardian as soon as is reasonably possible should medical attention be necessary.)

It is understood that students who violate conduct or eligibility rules or who act in a manner that is detrimental to the safety or well-being of others may be sent home at the parenfs expense.

I have read and agree to abide by the conditions stated above.

Student's Signature Date Parent/Guardian's Signature

5

PROVO CITY SCHOOL DISTRICT

EMPLOYEE AUTHORIZATION TO TRANSPORT STUDENTS

SCHOOL:

I, , will be using myf district owned vehicle to transport-'--- students to and from the following activity:

DESTINATION: _

DATE:

PURPOSE: _

I agree to follow the required State Risk Management volunteer driver's terms -including an online test and background check (test may be taken at htt;p://risk.utah.gov/loss/DriverVideoTest.html and background checks can be done at Provo School District Offices 280 W. 940 North, Provo, UT)

I agree to take the safest route to and from the activity location.

I confirm I will not be using a 15 passenger van or vehicle with more than 11seats.

When using my personal vehicle : my auto insurance and driver's license are currently in force and I acknowledge that my personal auto insurance policy is the primary insurance coverage. The minimum state liability bodily injury requirements are $25,000 per person and $65,000 per occurrence.

Please complete A or B -

A. Complete the following information:• Driver's License number: _• Driver's License expiration date:------• Vehicle Insurance company: _• Vehicle Insurance Policy number: _• Effective Dates of Vehicle Insurance Coverage: _• Proof of background check and driving test

B. Attach a photocopy of the following:• Driver License• Proof of Insurance Coverage• Proof of background check and driving test

When using District owned vehicle a. Complete the following information:

• Driver's License number: _• Driver's License expiration date: _

b. Attach a photocopy of the following:• Driver License

Driver Signature Date

Principal or Designee Signature Date

Utah State Risk Management Excerpt:

UseofVolunteersto Transport StudentsAll volunteers must be certified pursuant to the Utah Volunteer Government Workers Act, UCA 67-20-1. At a minimum, every volunteer must be approved by the Chief Executive (Superintendent) or his/her authorized representative and by the office of personnel.

All volunteers must also undergo a background check to confirm tbey are currently licensed to drive and to facilitate a review of their driving record. They must also take the defensive driving course that is approved by the Division of Risk Management.

Volunteers who transport minor children must also undergo a criminal background check. All volunteers should be at least 21 years of age, with preference to!bose whoare25 or older. No students may drive entity vehicles under any circumstances. No 12- or IS-passenger vans may be used under any circumstances.

FINANCIAL HANDBOOKTimpview High

This handbook is· intended to provide procedures and direction to staff on the handling of money, These procedures are based on state law, district policy, and best practice to ensure that all funds are handled appropriately.

Public Funds & Booster FundsTo clarify school fund raising from booster activities, the following general guidelines are provided. Public funds shall be defined as any activity that involves:

1. School/district employee acting in an official capacity, i.e. coaches/advisors raising funds to support their programs.

2. School/district assets, i.e. school property.3. School/district name and/or identity.

Funds from school fundraisers must be treated as public money, and all district/school financial policies and procedures must be followed.

Booster activities function outside the purview of the school and are clearly separated from school fundraising efforts. These activities originate and are managed by individuals not directly associated with the school. Booster groups may receive the following:

1. Advice from school employees, i.e. coaches/advisors identifying areas of need or support for school programs.

2. Rental of school facilities.3. Use of the school name and/or identity, so long as it is clear to all patrons that the

activity is associated with the booster group and not the school.

Booster groups may not:

1. Make any purchases in the name of the school or use the school/district's taxemption number.

Clearly distinguishing school funds from booster funds is critical to ensure that all state statutes and district policies are followed.

Money CollectionAll student fees and money may only be collected by the Financial Secretary. When money is collected the student will receive a receipt as proof of payment. In addition, staff may request a list of students that have paid various fees from the Fimincial Secretary.

2

Concessions & Gate ReceiptsIn order to avoid even the appearance of impropriety with school funds, staff should strictly apply the "rule of two" when handling money. This requires that two staff members are present whenever money is handled. Staff must adhere to the following procedure at the end of each event or activity where money is collected:

1. All funds must be counted and totaled by two staff members at the conclusion of the event or activity,

2. Staff members must initial deposit forms,3. All funds must be deposited in the school's safe or bank's night deposit on the

day of the event,4. An administrator must assist a staff member in depositing all funds, and5. The Financial Secretary will perform a double-counting of the funds deposited in

the school's safe within 48 hours of the event.

These steps are necessary to ensure the proper accounting of school funds. Please ask an administrator or the Financial Secretary if you have any questions.

Money BoxRequesting a cash box:

1. Ail n;quests must be made at least 3 days prior to the expected date.2. All requests must be made through administration. Requests must include:

a. Name of event · ·b.. Date of eventc. Supervisor & Program Advisor

3. Once approved, the cash box may be obtained from the Financial Office on the day of the event. Please pick up the cash box prior to 2:30pm.

4. Count the cash and ensure that the total amount is accurate.5. If total is accurate, sign the request form.

Possession of a cash box:1. Once you take possession of the box, you are responsible for it and its contents,2. Keep the cash box secure at all times.3. Two adults, who are not related, must be present at all times when collecting or

dispensing funds.

Returning a cash box:6. All funds must be counted and totaled by two adults, who are not related, at the

conclusion of the event or activity.7. Deposit forms must be completely filled out and signed by both adults.8. Money and deposit form must be placed in deposit bag and sealed.9. Bag must be filled out completely, including a signature, prior to deposit..10. All funds must be deposited in the school's safe or bank's night deposit on the

day of the event.11. An administrator must assist a staff member in depositing all funds.

Modified 3/01/13

3

12. Once funds are deposited, send a notification email to the Financial Secretary.13. The Financial Secretary will perform a double-counting of the funds deposited in

the school's safe within 48 hours of the event.

Banner AdvertisementGiven that banners that advertise local business are a source of funds for programs, the following guidelines should be followed:

1. All banners and locations must be approved by administration prior to printing and collecting of fees.

2. Sponsors must reflect the values and mission of the school. For instance, bars and taverns should not be solicited for sponsorship.·

3. All banners should be neat and uniform in size.4. Programs may only display banners during their season. At the conclusion of each

season, banners must be removed.5. Wintet sports must coordinate efforts to ensure equal access to the gyms to .

display banners. Programs that are unable or unwilling to fill their allotment of . banner space may give it to other programs to use.

6. Banners will only be permitted on fences, railings, etc.7. Funds must be deposited in the school account.8. Individual students may not be able to sell banners to offset their own personal

fees.

PurchasingAll purchases must adhere to the district's Purchase/Payment Procedures. Teams and programs will not be allowed to draw their accounts into the negative without prior permission from the principal. The following school procedures must be followed:

1. Purchase Orders (PO) must be used whenever possible2. Complete Requisition Form (gold form)3. Receive pre-approval from administrator4. Complete bidding process5. Verify sufficient funds are available through Financial Secretary6. Receive final approval from administrator7. Place order after receiving PO# from Financial Secretary8. Upon receipt of shipment, verify all items are received9. Turn in packing slip to Financial Secretary

Travel. All travel must be pre-approved by administration. The district and school board must

also approve all over-night imd out-of-state travel. All trips must substantially contribute to the core purpose of the team or program (see district policy).

Modified 3/01/13

4

FoodSchool funds may only be used on a limited basis to purchase meals or food for the following:

1. Team banquets or celebrations2. Parent meetings3. Staff meetings that are five hours in length and during a mealtime (an agenda and

attendance roster are required- see district policy).

FeesOnly school board approved fees may be charged and must be collected for students participating in athletics and activities. Only students that have completed the fee waiver process through the main office may receive reduced or waived fees.

Summer Camps & ActivitiesSummer camps and activities are recognized as a valuable time for team and program development. This procedure needs to be followed for all summer camps and activities:

1. Receive approval from administration for activity and facilities use2. Enter activity onto the school calendar3. Only school board approved fees may be charged4. Fees must be collected in the main office. Receipts will be provided5. All expenditures must follow school and district procedures6. Contact HR to determine rate of compensation for employees7. Coaches and staff may not be paid any outside organization for participating and

hosting a school sponsored camp or activity

Private LessonsState law prohibits any public employee from privately benefiting from their position. Consequently, no one may receive private payment for providing personal lessons or coaching to students.

Financial Secretary-Segregation of DutiesThe following procedures must be followed in order to ensure segregation of duties.

Receiving funds:• All money will be received and receipted by the Financial Secretary. All receipts

must be entered into the system by individual student and correct fee, donation or revenue category.

• The Principal will review fund activity each week.• The custodian of each activity account (coach or advisor) will review and sign

fund activity-report each month. Reports must be turned into an administrator.

Depositing funds:

Modified 3/01113

5

• The Financial Secretary will prepare the deposit.• The Principal's Secretary will verify the deposit, ensuring the composition of

cash, checks and credit cards. Principal's Secretary will initial the slip.• The Financial Secretary will deliver the deposit to the bank.• An administrator will sign·the validated deposit slip upon the Financial

Secretary's return. The slip will be attached to the deposit paperwork.

Issuing checks:• Purchase Orders (PO) must be used whenever possible.• Staff completes Expenditure Request.• Financial Secretary will initial form if funds are available in the department

account.• School administrator provides pre-approval for expenditure.• Once all required documentation is attached, the school administrator will

approve expenditure.• If expenditure exceeds $10,000, district approval is required.• The Principal will review the check reconciliation report each month.

Utah Public Officers' and Employees' Ethics Act(Utah Code 67.16)

67-16-5 (Effective 05/01/13). Accepting gift, compensation, or loan-- When prohibited.

(1) As used in this section, "economic benefit tantamount to a gift" includes: (a) a loan at an interest rate that is substantially lower than the commercial rate

then currently prevalent for similar loans; and(b) compensation received for private services rendered at a rate substantially

exceeding the fair market value of the services.(2) It is an offense for a public officer or public employee, under circumstances

not amounting to a violation of Section 63G-6a-2304 or 76-8-105, to knowingly receive, accept, take, seek, or solicit, directly or indirectly for himself or another a gift of substantial value or a substantial economic benefit tantamount to a gift:

(a) that would tend improperly to influence a reasonable person in the person's position to depart from the faithful and impartial discharge of the person's public duties;

(b) that the public officer or public employee knows or that a reasonable person inthat position should know under the circumstances is primarily for the purpose of rewarding the public officer or public employee for official action taken; or

(c) if the public officer or public employee recently has been, is now, or in the near future may be involved in any governmental action directly affecting the donor or lender, unless a disclosure of the gift, compensation, or loan and other relevant information has been made in the manner provided in Section 67-16-6.

(3) Subsection (2) does not apply to:(a) an occasional nonpecuniary gift, having a value of not in excess of $50;

Modified 3/01113

6

(b) an award publicly presented in recognition of public services; (c) any bona fide loan made in the ordinary course of business; or (d) a political campaign contribution.

67-16-5.3 (Effective 05/01/13). Requiring donation, payment, or service to government agency in exchange for approval •• When prohibited.

(1) It is an offense for a public officer, public employee, or legislator, undercircumstances not amounting to a violation of Section 63G-6a-2304 or 76-8-105, to demand from any person as a condition of granting any application or request for a permit, approval, or other authorization, that the person donate personal property, money, or services to any agency.

67-16-5.6. Offering donation, payment, or service to government agency in exchange for approval -·When prohibited.

(1) It is an offense for any person, U:rider circumstances not amounting to aviolation of Section 76-8-103, to donate or offer to donate personal property, money, or services to any agency on the condition that the agency or any other agency approve any application or·request for a permit, approval, or other authorization.

67-16-6 (Effective 05/01/13). Receiving compensation for assistance in transaction. involving an agency •• Filing sworn statement.

(1) It is an offense for a public officer or public employee, under circumstancesnot amounting to a violation of Section 63G-6a-2304 or 76-8-105, to receive or agree to receive compensation for assisting any person or business entity in any transaction involving an agency ...

Modified 3/01113

Provo City School DistrictPolicy Series 6000 Finances and Operations

Donation and Fundraising Policy

Policy No. 6110

PurposeThe Provo School District Donation and Fundraising Policy encourages community partnerships that strengthen and enhance school programs and creates a climate of participation and cooperation between community organizations, private citizens, and the district's schools by:

• Sharing resources that benefit students and improve educational programs.• Involving the schools and the private sector in cooperative efforts that enhance the

quality of education for students at all levels.• Protecting students, parents, teachers, and school administrators from over

commercialization and fundraising efforts that are exploitative, coercive, disruptive to the educational process, threatening to the health and welfare of students, or lacking in educational merit.

• Implementing a smooth and orderly procedure whereby schools and communities cancooperate and share resources.

• Assuring public funds are safeguarded and are properly accounted for in a transparent manner.

• The District will manage, restrict or decline funds, gifts, or fundraising activities to assure that fundraising and expenditures comply with applicable district and state and federallaw and guidelines, including Title IX.

Guiding PrinciplesTo further the Purpose articulated hereinabove, the District is guided by the following fundamental principles:

The District encourages the contributions of gracious donors who have the resources and the inclination to augment the District's programs through philanthropy. The District is committed to effectively work with such donors to:

Provide the donation receipts that are mandated by law and encourage appropriate. acknowledgment, and facilitate the donor's charitable intent to the extent that it is in harmony with the educational goals of the district and approved by appropriate district personnel. Donation receipts for in-kind donations are to list the item(s) donated only. No value is to be assigned in-kind donations by the district on the donation receipt or acknowledgement.

The District desires to provide reasonable regulation of the process of fundraising and accepting charitable gifts. Such regulation should include principles of accountability, record keeping, and

appropriate protocols for safeguarding donated funds and protecting confidential information, and proper use of the tax-exempt status.

The District shall equitably distribute state approved tax revenue funds for its schools' primary educational functions. Those funds work to ensure that each school receives the fundamental educational supplies, materials, instructional equipment, and personnel necessary for the education of all students.

Fundraising is permitted within the district to allow the district and schools to raise additional funds to augment academic and co-curricular programs and to engage private citizens and community organizations in elevating the education and opportunities of the district's students.

The District recognizes that donations and fundraising efforts and results, may vary between schools. The District is, however, committed to appropriate distribution of unrestricted funds and the management of fundraisingldonations to assure that the educational opportunities of all of its students are reasonably similar and in compliance with applicable legal standards. TheDistrict is also committed to assisting and encouraging school administrators and staff in proven, successful fundraising principles and practices that will allow schools to augment their budgeted programs with charitable funds.

The District is committed to principles of gender equity and will use its facilities, unrestricted gifts, and other district funds in harmony with those principles (Title IX). The District recognizes that fundraising is driven by a donor's inclination for giving and that private donations may be directed or restricted by individual donors. While reasonable efforts will be made to use donations and fundraising revenues as designated, these funds are revenue of the District and can be used at the District's discretion to assure that educational opportunities are compliant with applicable legal standards.

The District will provide a healthy environment for appropriate fundraising by promoting student safety, reducing the pressure placed on students, and decreasing the prospect of excessive or duplicative soli<;itation of funds.

The District is ultimately responsible for the expenditure and allocation of all monies including those that are obtained through fundraising and gifts. As such, District procurement policies must be followed, and donations may not be specifically directed to any specific vendor or employee.

Officially Sanctioned Fundraising ActivitiesSchools, student clubs and organizations, sports teams, individual classes, booster clubs, PTA's and PTO's, and the community councils within the Provo School District may conduct fundraising activities for the benefit of the schools, students, and student organizations within the District. This policy provides guidelines for those fundraising efforts and a means for giving approval for such activities.

Page 12 Policy 6110 Donation and Fwulrai.sing

Definitions"District" or "School District" herein means the Provo City School District. "Superintendent" refers to the Provo City School District Superintendent of Schools.The terms "Board", "School Board", or "Board of Education", refer to the Provo City SchoolDistrict Board of Education."Schools" refers to the individual schools operated by the Provo City School District."Donor" refers to any individual, group, association, business organization, or charity, interested in making gifts (in cash or in kind) to the District or any of its schools.The term "private fundraising activities" shall include activities hosted by school booster clubs and/or any other outside organization such as PTAs and PTOs not specifically sponsored or under the organizational control of the District or one of its schools as defined in B2.1.Utah State Code 51-7-3 paragraph (25) defines public funds as: "Public funds" means money, funds, and accounts, regardless of the source from which the money, funds, and accounts are derived, that are owned, held, or administered by the state or any of its boards, commissions, institutions, departments, divisions, agencies, bureaus, laboratories, or other similar instrumentalities, or any county, city, school district, political subdivision, or other public body.

Authorization and SupervisionExcept as provided in Section 6 herein below, school fundraising activities must be approved in writing by the principal or superintendent and must be supervised by a member of the faculty appointed by the principal or superintendent for that purpose. Funds collected though fundraising efforts must be deposited in a dedicated account under the direct control of the school or school district, including, but not limited to, the Provo School District Foundation. Principals shall not transfer or otherwise expend donated or fundraised funds in a manner contrary to donor restrictions or the fundraising purpose.

Fundraising activities involving any of the following criteria are school and district fundraising activities and require express written approval of the school principal or superintendent:

• The use of a school or district name unless written permission is granted.• The use of students while under the school's or district's responsibility:• The use of school or district faculty or employees while they are being paid by the school

or district.• The use of school or district property or facilities unless the property and/or facilities are

properly rented in accordance with the District Rental Policy.

Private Fundraising activities must clearly identify the fundraising activity under a name other than a school or the district, and students and school and district employees .cannot identify themselves as students or school and district employees in the fundraising efforts.

Permission to use the school or district name may be granted in writing by the Board or superintendent to private fundraising activities by submitting Form 6110 F1 if the following criteria are met:

Page 13 Policy 6110 Donation and Fundraising

• Finances are publicly transparent and reported in a public meeting at least annually.• Financial records are reviewable upon request at reasonable times and places.• Where practical, pre-numbered receipts are issued for all donations.• The fundraising activity clearly identifies the funds are going to a private entity.

Approval CriteriaSchools and the district may engage in fundraising efforts to enhance:

• Academic programs.• Travel incidental to academic study, athletic competitions, or performance competitions.• Sports and other related physical education and recreational programs.• The occupational development of students.• Performance opportunities.• Facilities and equipment that will enhance student opportunities and programs.• Humanitarian projects.

General Fundraising StandardsFaculty and student participation in fundraising shall be strictly voluntary.

Participation in fundraising may not impact a student's grade.

Students shall not be required to participate in fundraising activities as a condition for belonging to a team, club, or group; nor shall a student's fundraising effort affect his/her participation time or standing on any such team, club, or group.

School principals must approve the awarding of rewards or prizes to groups, classes, or students participating in any fundraising activity. Competitive enticements for participation are, however, discouraged.

Schools may not impose sales quotas (or the like) as a part of fundraising efforts, and students shall not be required to pay for any unsold items that are returned to the school.

Door-to-door sales are prohibited for all students in elementary and middle schools in the district. High school students are exempted from this prohibition, but suitable procedures must be used by the schools, administrators, and supervising faculty to safeguard students who are going door-to-door.

Partnerships between schools and businesses that augment school programs and activities are encouraged.

Any use of district schools, facilities, or equipment for private fundraising activities must be approved by the superintendent or principal of the proposed facility and will be subject to the

Page 14 Policy 6110 Donation and FundraJsing

District Facility Rental Policy, unless a waiver is obtained from the superintendent in writing and proper insurance is provided.

Fundraising activities that involve intense sales strategies or that would expose students and other participants to the risk of personal injury or liability will not be approved.Approval should not be granted for fundraising activities that would expose the school or districtto risk of financialloss or liability if the activity is not successful.

School and district fundraising activities will be accounted for using established school and district accounting systems and procedures. Records of fundraising efforts, including accurate reporting on participation levels and financial outcomes, shall be open to the parents, students, and donors. Nothing herein shall be interpreted to require or authorize the release of personally identifiable information protected by FERPA.

Community fundraising events will not be endorsed or sponsored by the district or its schools without the express written consent of the principal of the school or the superintendent of the district. Materials that advertise community fundraising activities may be placed in the school office or other locations identified by the school principal or superintendent.

Supervision CriteriaAll proposed fundraising projects must be submitted in writing to the principal or superintendent before any fundraising activity begins. Approved projects should be scheduled throughout the school year to avoid conflict, confusion, and excessive fundraising pressures.

General supervision will be under the direction of the principal or superintendent with specific supervision by a member of the faculty or other district employee as appointed by the principal or superintendent for that purpose.

Fundraising monies must not directly or indirectly compensate any individual teacher or school district employee by direct or indirect payment, commissions, or payment in kind. Fundraising monies may be used for the travel of teachers or school district employees who will be student supervisors or chaperons on district approved travel if the fundraising effort fully discloses the intended use of the funds.

Large Donations and Large Fundraising or Capital CampaignsAs specified in District purchasing policies and procedures, principals have revenue and expenditure authority up to $10,000. Any fundraising effort that seeks to obtain donations from many donors or from a select group or individual, where the objective is to raise more than ten thousand dollars ($1 0,000), requires superintendent and business administrator approval. Fundraising efforts where the objective is to raise more than fifty thousand dollars ($50,000.00) must be approved by the Provo City School District Board of Education.

Page 15 Policy 6110 Donation and Fundraising

Voluntary donations from private individuals or organizations (such as booster clubs, PTAs, PTOS, District Foundation, etc.) in excess of $10,000 require the superintendent's approval. Voluntary donations from private individuals or organizations in excess of fifty thousand dollars ($50,000.00) must be approved by the Provo City School District Board of Education. The District encourages large gifts and donations to be made through the foundation.

Organizations and schools seeking approval of large donations or large fundraising efforts must submit to the district all information requested by the district or its appointed administrator before consideration may be given. This information may include (but is not limited to) prospective building plans, proposed naming opportunities, details regarding any structuring of gifts, payment arrangements, loans or financing, or other information that will allow the district to accurately assess and determine the merits of the proposed fundraising effort or gift. Donors may remain anonymous.

The District reserves the right to conditionally grant permission to the donations or large fundraising efforts described in this section, including the requirement that some conditions need be satisfied before a donation is accepted or a large fundraising effort is initiated.

The District also reserves the right to control its assets, facilities, and resources. Proposed improvements to school property in the district will require that the District manage and control such improvements, and that the implemented plan include consideration for managing any increased maintenance and/or maintenance costs required by the proposed improvements. All improvements on district owned property shall comply with state procurement laws.

The district superintendent must pre-approve signs, banners, or other forms of advertising larger than fifty square feet proposed to be placed on the outside of the district's facilities or grounds.

Schools may not begin a fundraising campaign or accept a donation described in this section without first obtaining the approvals required under this section. School representatives should not give assurances or make promises to donors desiring to make large gifts (as defined in this section) before approval of the proposed gift is granted by the superintendent.

Naming Opportunities and RestrictionsThe physical facilities of all district schools are owned and operated by the District. No part of any school facility or equipment may be named by or for a donor without the express written consent of the Board. The Board, at its sole discretion, will consider naming rights for donations on a case by case basis.

All donations with naming opportunities must be accompanied by a letter of understanding (or similar document defining the limitations, conditions, and details of the right so granted).

Page 16 Polley 6110 Donadon and Fundraising

Provo School DistrictPolicy Series 6000 Finances and Operations

Donation and Fnndraising Policy

Approval of Provo City School District Sponsored Fundraising Event or Donation6110F3

Per policy 6110, Donation and Fundraising, any fundraiserwhich uses students while under school responsibility, uses district employees during work time, or uses district property or facilities without being rented per district rental policy requires prior principal approval. Any donation or fundraising efforts expected to generate more than $10,000 also requires prior superintendent and business administrator approval. Donations or efforts expected to raise more than $50,000 also requires prior board approval. Any use of the District or school name(s) requires pre-approval using form 6110 FL

Description of the fundraising event and activities or donation including relevant dates and expected proceeds:

Proposed use of any proceeds:

If students are involved, describe steps to be taken to properly supervise students and keep students safe. List employees assigned to supervision:

List any proposed donor restrictions for the use of any proceeds:

Donor signature: Date: _

District Employee orFaculty member event sponsor: Date: ---::--::-c-:-.,--cc--.

By signing employee acknowledges you have read, understand, and will conduct the fundraising event according to district policy 6110.[Below this line for office use only]

APPROVALS

Principal: Date: _

Business Administrator (over $10,000): Date: _

Superintendent (over $10,000): Date: _

Date of Board Approval (over $50,000): Date: _

The Fundraising Policy can be located on the District website at policies.provo.edu

The District shall only grant naming opportunities that are consistent with the mission and values of the district and the community it serves, and those opportunities must be in harmony with the educational objectives of the district.

Compatibility with other District Policies and RegulationsThe Board's determination resolving matters of conflict shall be final in the event that any provision of this policy conflicts with other preexisting Provo School District policies already in place prior to the effective date of this policy or which may be enacted at some future date.

Legal References:

Utah State Board Rule 277-113 Utah State Code 67-16

LEA Fiscal Policies and AccountabilityUtah Public Officers' and Employees' Ethics Act

Technical Modifications:Updated:

July 23, 2012May2014

Approved by Board of Education: May 13,2014

Page I 7 PoUcy 6110 Donation and Fundralslng

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QUOTATION SHEETProvo City School District

(Please list supplies and equipment on separate quotation sheets)

SchOol/Location: -----------------

Vendor

Address

P.O.#------- ---Date OrderedPrepared By: -:-----

QUOTE! QUOTE2. QUOTE3

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Fax# .Quoted by . '

When State Contract/Bid #

TermsQTY ITEM DESCRIPTION Unit Cost Total Unit Cost Total Unit Cost Total

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-Delivery/Shipping Charges

Total Quote

Sole Source Procurme11tshall be used only if a requirement is reasonably a-vailable from one supplier; A requirement for a particular proprietary item does not justify a olepotential bidder or offeror for that-item. Exatriples of circumS ncdsI) :where the cOmpatibility of equipment, accessories, replacement

· · parf.:s or S(!.::Viesupplier's eis needed for trial use or testing. 3) Purchase of items for re ale. f'lt!llS!

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cSOLE SOURCE/SINGLE SOURCE PROCUREMENT

JUSTIFICATION FORMProvo City School District

Utab Pro urement''Sole source procurement shall be used only if a requirement is reasonably available from one SUpplier. A requirement for·a particular proprietary item does not justify a sole source purchase if-there is more than one potential bidder or offeror for that item. Examples of circumstances which Could necessitate a sole source purchase ai-e: 1) where the.compatibility of equipment, accessories, replacement parts or service is"th"e

· paramount conSidenltion: 2) Where a·sole supplier's item is needed for trial use or testing. 3) Purchasofitems for resale. 4) Purchase of public utility service.s". . · · · '

Any request of$351 or more by a school or department, that procuremerit be restricted to one' potential vendor orcontractor, shall be accompanied by an exp ationacceptable i:o meet the need: A rec}uiremf;Ilt for a particular proprietary item does not justify a sole source ·procurement if there is more than one potential bidder or offeror. Each requeSt shall. be submitted in writing by therequesting school(departm ntshould be solicited. The tina) determination as to whether procurement shall be made as a sole source, shall be made by the Purchasing Department (see PCSD Procurement Policy).

-····-·--··-·· -------·----·--·----··-------·------··----·--------·-..:..1=--·--·--------- Piease write any explanation and justification in the space provided below. Provide all supporting documentation. Use a separate sheet if necessary. '

Vendor/Contractor:--------------- ------'--'-- Date of Request: -:-::::--,------'--RequeSting School/Department:-----------------=---Signature of Requestor:._ -,-----------,-- Date:._ ------- Signature of Supervising Administrator:------------ Dat :.Purchasin!l pepartment Approval:----------,------ Date:. _:_

•

Explanation/Justification

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Timpview High SchoolBanner Program Fundraiser

Program _Student Athlete's Name _ Phone#

Sponsor/Company Name.Phone# _

Timpview High School appreciates your support of student athletes and the different programs with your sponsorship of a banner. The proceeds of your donation will go directly to the reduction of participation fees for the student athlete and to the specified program.

Your personalized full color banner (4'X6') will be prominently displayed throughout the entire 2013 season of the program specified. In the space below, please provide the information that you would like to have on the banner. If the program is creating your banner, we encourage that all personal design I logo/ layout information be submitted on a CD - rom using Adobe Illustrator file or an EPS fil.e... If you have any questions or special requests, please ask the student athlete orparent who contacted you to pass along your phone number to the program advisor.

Banner will read:-------------------------

A first year banner (which includes cost to make your banner) is $500. For past sponsors, the renewal of an existing banner is $300.Sponsors may also provide a personally provided banner for $300.

*All banners created or provided from 2013 and forward will be approximately 4' X 6'.

*Please make checks payable to Timpview High School. The check should be mailed or delivered to:

Financial OfficeC/0 Timpview High School3570 N. Timpview Dr. Provo, UT 84604

*All banners must have prior approval from Timpview Administration.Administration Signature Date, _

$ 150.00s 385.00s 360.00$ 100.00$ 75.00$ 50.00$ 300.00s 80.00$ 100.00$ 150.00$ 355.00

s 20.00$ 40.00$ 19.20s 15.00$ 5.00$ 30.00s 10.00$ 20.00s 5.00$ 10.00s 20.00$ 10.00$ 15.00$ 5.00$ 12.00s 10.00s 25.00s 10.00

$ 90.00$ 165.00$ 350.00$ 10.00$ 180.00s 125.00$ 350.00$ 140.00$ 65.00$ 50.00$ 300.00$ 20.00$ 40.00$ 75.00$ 10.00$ 50.00

$ 70.00$ 100.00s 150.00$ 70.00$ 100.00$ 70.00$ 150.00$ 150.00s 150.00

$ 15.00$ 15.00$ 15.00$ 18.00$ 20.00$ 5.00

$ 15.00$ 60.00$ 65.00

School Fees - High SchoolsTimpvlew High School

Fee Amount Fee Amount

GENERALREOUIRED FEE All Students

CLASS FEES AccountingAPArt Supplies (semester) AP Biology Worl<bookArt Supplies (semester)Business Classes (Semester)Ceramics Supplies (Semester) Family & Consumer Science LabFoods (Semester) Medical Principles Multi-MediaPhotography (Semester) Physical Education Physiology LabScience LabsShop ClassesSports Medicine LabSports Psychology Worl<bookWorld Laoguage Lab

VOCATIONAL CLASSESStudents pay for supplies and materials for personal projects

PARTICIPATION FEESAdvanced DramaAthletic Teams (except Football) Ballroom TeamBand/OrchestraCheerChoir (except Mixed) Colorguard (Fall) FootballMarching Band (Fall)

CITATION:State Constitution Art X, Sec 3

2014-15I s too.oo I

PLAYER PACKET (not to exceed)All Sports I s

SUMMER CAMPS (not to exceed) BaseballBasketballCheer Camp Colorguard Summer Dance Company Drill TeamFootballMarching Band SwnmerSoccer Softball Volleyball

SPECIAL ACTIVITIES A Cappella DressA Cappella SuitCheer UniformClass Change Fee (non essential)Dance CompanyDebateDrill/Dance CompetitionDrivers EducationMadrigal DressMadrigal SuitMarching Band Fall Tour Math Calculator Rental Mock TrialMusical Instrument RentalParking PassStudent Govenunent

CLUBS & MISCELLANEOUS FEES DECAFBLAFCCLAHOSA MembershipKey Club

NHS Membership

2014-15too.oo I

Revised Statute 53A-12-102Revised Statute 53A-12-201Revised Statute 53A-ll-806(2) Administrative. Rule R277-407Doe v. Utsb State Board of Education, Civil #920903376Provo City School Board Policy #

PTSA Donation (Sugg.) $ -PTSA Membership (Each) $ -Skills USANICA YearbookYearbook (after Jan I)

Out-of-Boundary Student Orientation

Welcome to Timpview High School! We are very pleased that you are interested in attending our great school, as we understand that you have many choices when it comes to the education of your child. We truly believe that we are preparing thenext generation of leaders. We pride ourselves on our very strong academic, athleticand activity programs, and we know that our graduates are well prepared for the next stage of life.

We have prepared the following process to assist you in learning more about what Timpview has to offer. This process is designed to ensure that your needs. are met, and we ask that you follow the process as outlined.

1. All visitors to our campus must check in at the front office and receive a visitor's badge. This ensures the safety of our campus and allows us to direct you to the individuals that can assist you.

2. Visit the Counseling Center and pick up a copy of our Parent's Guide, Program Planning Guide, and enrollment forms. These documents will provide detail on all of our academic offerings and the operation of the school. In addition, you may begin the enrollmentpaperwork at this time, if you desire.

3. While in the Counseling Center, you can make an appointment to meet with a counselor. Our counselors will assist you with .course selection and answer any questions that you might have about our many programs. If you would like to meet a teacher or advisor from a specific program, an introduction can be arranged through this office.

4. If you are interested in a sport, you can make an appointment in the Main Office to meetwith our Athletic Director. Our Athletic Director will be able to answer any questions about our athletic programs, as well as questionsabout eligibility. If you would like to meet a coach from a specific program, an introduction can be arranged through theAthletic Director. We ask that you not directly contact our coaches prior to enrollment.

5. Finally, we are happy to provide you with a tour of our facility if you are interested. A tour of the building may be arranged through the Main Office. All tours will occur after the end of the school day at 2:15pm.

We hope that this process is useful as you prepare to make your transition to Timpview. Additional information about summer programs, etc. may be accessed on the Timpview website at: www.timpview.provo.edu.

We look forward to seeing you on campus. GoT-Birds!

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· · : lnstructionetForhParent l.Register My Athlete alloparents to registei" theirathletes for sports onnne.• Here a;;orne basic steps to follow when' registering your athlete for the first time:

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Fu re . . . . . . . . During the following,.yea J ron your,athlete.IJt s.to follow.s p tl,) reQi$terfPrt llOrts; ._.· ·• · .·.· .• i

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- _ ............··--·-.-,,.... ·------··

LEARN MORE

ATTENTION: Students & Parents/GuardiansThe Utah High School Activities Association has been the leadership organization for education-based athletics and fine arts activities since 1927. Along with music, forensics, and theatre, the UHSM sponsors ten sports for girls and ten sports for boys. To participate, students must be eligible accordinto UHSMstandards. The purpose of this flyer is to provide you with some information on the eligibility rules andthe Transfer Rule. It is important to KNOW THE RULES!

To be eligible to compete:• You must be a 9th -12th Grader

• You must be a full-time student

• You must earn a 2.0 GPA the grading period prior to trying out.

• You cannot earn more then one F;( a uNG" or "I" is calculated as a F) ·

• You cannot turn 19 years old beforeSept. 1the year you intend to play.

If you attend a charter, home, private, online or alternative high school, you may only participate

·in extracurricular activities at the school within whose boundaries your parents or legal guardi ans reside or at the public school from which you withdrew for the purpose of home schooling orto attend the charter or private schooL Charterand private school students may only be eligible at a public school for sports not offered at theirschool.

UHSAA SportsBaseball Basketball <Gf8>

Cross Country (G/8)

Drill <G>

FootballGolf (G/8)

Soccer (G/8)

SoftbaII (G)

Swimming/Diving (G/8)

Track & Field (G/8)

Volleyball <G>

Wrestling·

UTAH HIGH SCHOOL ACTIVITIES ASSOCIATION

..-··-····

lEARNMORE

you establish your initiaStudents establish their initial eligibility when they attend high school for the first time OR when they tryout and are selected as a member of a high school team.

When a 9th grader from a junior high school tries out for and is selected as a member of a high school team (Freshman,Sophomore,JV or Varsity), they have established their eligibility at that high school and are not eligible at another high school. An unsuccessful tryout does not establish a student's initial eligibility; however,it does end a student's sport season preventing them from trying outfor the same sport at a different high school that same school year.

Students and parents/guardians are encouraged to learn the rules, consider their options and carefully "choose" where they want to establish their initial eligibility.

What happens if you transfer schools? According to the UHSAA Transfer Rule,a student transferring from one high school to another high school is NOT ELIGIBLE TO COMPETE in UHSAA athletics (at any level) for twelve months from the first day of attendance at the new school. The Transfer Rule also applies to students transferring to an alternative high school or transferring in from out-of-state.

If a student enrolls at a new school during the summer,they will not be eligible for activities until the following school year, sitting out from one summer to the next.

Can the UHSMwaive the ineligibility? The UHSAA has the discretion to waive the period of

ineligibility when a student transfers to a new school as the result of a bona fide change of residence,recent divorce or documented hardship. The change of residence shall be into the estab lished attendance area of the high school to which the transfer is made. A hardship is defined "as an unforeseeable, unavoidable, and uncorrectable act, condition or event which causes the imposition of a severe and non-athletic burden upon the student and/or his/her family." In the case of a bona fide change of residence or re cent divorce,parents or legal guardians must submit a completed "Change of Resi dence" application,required signatures and supporting documents to the UHSAA office. In the case of a hardship,a completed "Hardship Waiver" application, re quired signatures and third party documentation must be submitted for review.A "Change of Residence" or "Hardship" application can be submitted to the UHSAAafter the student has enrolled at the new school or upon proof of enrollment during the summer. Allow 4-6 weeks for a final decision to be made and the family and school will notified by the UHSAA. A student is ineligible to compete for their new school until they have sat out 12 months or they have been notified by the UHSAA their transfer application was approved. Ineligible students are allowed to practice.

GO TO UHSAA.ORG & CLICK ON TRANSFER TAB TO DOWNLOAD APPLICATIONS.

H SCHOOL ACTIVITIES ASSOCIATION

TIMPVIEW

TRYOUT CHECK LIST

ALL PAPERWORK MUST BE TURNED IN BEFORE AN ATHLETE CAN TRYOUT

v" UHSAA Tryout Check list Formo Eligibility -Check only the appropriate boxeso Signatures required by athlete, guardian & coach

-1 PHYSICALSo Requires insurance information, guardian, athlete and physicians signature

-1 CONCUSSION LETTER & CONSENT FORMo Fact sheet for athletes o Fact sheet for parents o IMPACT Registration

-1 CODE OF CONDUCTo Requires Athlete and Parent Signature

-1 ANTI-HAZING AGREEMENT

-1 STUDENT/PARENTCONFIRMATIONFORMo The Handbook is online at http://www.timpview.provo.edu/index.php/athletics/

-1 PLAYERINFORMATIONSHEET

-1 COPY OF PREVIOUS TERMS GRADES

UTAH HIGH SCHOOL ACTIVITIES ASSOCIATION199 E 7200 So, Midvale, 84047, Ph 801-566-0681, Fax 801-566-0633

UHSAA Tryout Checklist FormFor Prospective Student-Athletes, Parents/Guardians & Coaches

Revised 1/8/13

To be completed by prospeclire student-<Jthletes and parents/guardians prior to trying out for a high school team at any level (i.e.ra,ity, JV, soph, freshman). ilimpletedfonns shall be reviewed by the head coach and athletic director to determine eligibility before being placed securely onjile at the schooL

Before completing this form, please carefully read the following information regarding eligibility:Initial eligibility is established by attending a high school OR being selected as a member of a high school team. Once a student has established their initial eligibility by attending a high school or being selected as a member of a high school team, they are nat eligible to participate at another high school far twelve months from the first day of attendance at the new school or until a "Change of Residence" or "Hardship Waiver" application has been approved by the UHSAA and the school notified (approximately 4-6 week process).

Studenrs Name Grade Date of Birth

Name of the Sport High School Sponsoring this Sport School Where You Are Currently Enrolled

List all schools attended (i.e. junior high or high school, public, private, charter, alternative,home, virtual}:

9 Grade 10 Grade

11th Grade 12 Grade

PART 1-ELIGIBILITY : The prospective athlete must answer the following questions. Check "Yes" or "No."Yes_ No_ Are you enrolled at or do you attend another school, different than the one sponsoring this sport's team?

If you answered YES, print the name of the school where you are enrolled: _ Yes_ No_ Have you attended another high school in the last 12 months? Print the name(s) of any other high school(s)

you attended in the last 12 months: _If you answered YES,did the UHSAA approve your "Waiver of Ineligibility" application? Yes No_

Yes_ No_ Have you been a member of a high school team at another high school in the last 12 months?If you answered YES,list the name(s) of any other high school(s) where you were selected as a member ofa team in the past 12 months: _

If you answered YES, did the UHSAA approve your "Waiver of Ineligibility" application? Yes_ No_ Yes_ No_ Are you a Foreign Exchange Student (J-1Visa) or an International Student (F-1Visa)?

If you answered YES, did the UHSAA approve your participation (Form 4A or 4B)? Yes_ No_

Attention Coach & Athletic Director: Follow-up is required on any question marked "Yes» by the prospective player.If a prospective athlete is NOT ENROLLED AT YOUR SCHOOL, verify which of the following applies: 1) Do they attend a junior high or middle school?2) Were they approved by the UHSAA for participation under the Co-Op Rule? 3) Do they attend an aftemative, charter or private school or are they home schooled or a full-time online student AND if so, do their parents or legal guardians reside in the boundaries of this school? The charter, home or private school student may only participate in extracurricular activfties at the school wflhin whose boundaries the student's parent(s) or legal guardian(s) resides or at the public school from which the student wflhdrew for the purpose of home schooling or attending a charter or private school (Handbook Article 1 Section 14). On game day, ineligible players are NOT allowed to be in unifonn,wann-up,be introduced or compete for your school.

PART 2-RULES : The following section must be completed by the prospective student-athlete.As a participant,I will adhere to all UHSAA Rules and By-Laws outlined in the UHSAA Handbook,some of which are included in the commitment statements listed below. After reading through each statement below,CHECK THE BOX as an indication of your understanding and commitment to adhere to the rule as stated.

D I may participate in only one season per sport in any school year. A tryout is considered participation in a sport and an unsuccessful tryout concludes my eligibility for that season. If I do not make this team, I cannot tryout at another school for this same sport during this school year (Article 1, Section 3).

D I establish my initial eligibility by attending a high school OR by trying out for and being selected for membership

on a high school team (Art. 1,Sect. 1).D According to the "Transfer Rule," if I transfer from one high school to another I am ineligible to participate in UHSAA

athletic activities for twelve months from the first day of attendance at the new school (Article 1,Section 9).

D I must meet the scholastic eligibility rules ofthe UHSAA which include a minimum 2.0 GPA on a 4.0 scale or its equivalent and no more than one failure in the preceding grading period (Article 1,Section 8).

D I will riot compete with any non-high school teamin this same sport after the competition start date for this sport(Article 1, Section 12). For competition start dates see the UHSAA calendar at

www.uhsaa.org. D I cannot participate in more than four seasons in any one sport (Article 1, Section 3).D I must obtain a physical examination prior to competing in any athletic contest (Article 1,Section 13).D I will conduct myself in a manner that promotes good sportsmanship. I will respect the game and all participants. D I will not promote,distribute or use illegal substances as defined in Utah Code and the UHSAA alcohol, drugs and

tobacco policy (Article 10).D I cannot participate on a college team or a team that includes professional athletes (Article 1,Section 5 & 6).D I will not compete for money or accept any cash awards in any organized athletic activity (Article 1, Section 6). D I could lose eligibility for one full year if involved with recruiting. Recruiting of student-athletes by a member

school,coach,coaching staff,boosters or anyone else is considered a serious violation of UHSAA rules regardingthe imposition of undue influence for the purposes of athletics.

D I certify that I have not been recruited to attend this school for purposes of athletics.

PART 3-SPORTSMANSHIP PLEDGE : Read through the UHSAA Sportsmanship Pledge and Sign Below

UHSAA SPORTSMANSHIP PLEDGEI accept the responsibilities that come with the privilege of participating and make a pledge to exhibit appropriate sporting behavior and be a positive role model for my team, school andcommunity.

IPLEDGE TO:1. Play with honesty and integrity, adhering to the rules of the sport

and the UHSAA rules, regulations and By-Laws.2. Demonstrate respect for the game and all those that participate.

(i.e. teammates,opponents, coaches, officials, spectators and fans).3. Display self-control and appropriate behavior when participating and by

cheering FOR my team and NOT against the opponent. "Do Rowdy Right!"

"Raise the Bar"- Sportsmanship Matters! Raise-the-Bar is the UHSAA Statewide Sportsmanship Program for all member schools. Together we can make a positive difference in the lives of or students, schools and communities!

SIGNATURES REQUIRED BY PROSPECTIVE ATHLETE, PARENT AND COACH We hereby certify that we understand the UHSAA By-Laws outlined on this form and agree to abide by these and all others outlined in the UHSAA Handbook located under the "Publications" tab atwww.uhsaa.org. We certify that the student-athlete is eligible to participate in UHSAA activitiesaccording to the UHSAA eligibility rules and By-Laws. We also agree to abide by the SPORTSMANSHIP PLEDGE stated above. We pledge to RESPECf THE GAME AND ALL THOSE PARTICIPATING• .

Signature of Student-Athlete Signature of Parent or Guardian

Signature of Coach Date

Page I oj3

HSAAUtah High School Activities Association

199 East 7200 SouthMidvale, Utah 84047Phone:801-566-0681

Fax:801-566-0633

Updated 7/1912012

Directions:Please type and fill all fields electronically, except signatures. Print the document (you cannot save the form on yourcomputer), attach supporting

Web: www.uhsaa.org I Email:submit@uhsaa.org

Change of Residencedocumentation, collect all necessary signatures, and submit to the UHSAA office either by fax{801-566·0633) or mail.

Please be sure to include this cover page with the necessary documents listed below

"' )four recn..ues!. Atl!!.not g;wocessel:!ltull'i:i! < lfi llecessa jlfitaJ!ione A valid email address m .ast be submitte(J

• Check the reason for the change of residence• Check the boxes under the appropriate reason after attaching necessary documents• Allow 4-6 weeks for a ruling

Please fill out all fields. except signatures. electronically

Q Full Family Move 0 Attach two separate pieces of evidence documenting the new residence

(see application for examples of documentation)0 The attached two-page form completed with all signatures0 A copy of current transcript

OR

,..:)Divorce0 Attach a copy of the Divorce Decree and list the Civil Number0 The attached two-page form completed with all signatures

0 A copy of current transcript

Student's Name Receiving School

Parent/Guardian Valid Email Address

Date

"

"

Page 2 of3 Updated 7119/2012Utah High School Activities Association

Phone: 801-566-0681 Fax: 801-566-0633Web: www.uhsaa.org I Email: submit@uhsaa.org

Form to Request a Waiver of Ineligibility Due to Transfer

Change of Residence

Transfer Student Information:

Name of Student Date of Birth AgeQ9th Qto'h Outh QI2'h

Grade in which Enrolled at Receiving School

Sending School (school from which student transferred) Receiving School (school to which the student transferred)

Address (Student and Parent/Legal Guardian Current Residence*) City -- Zip

Date on which Student First Occupied the Current Residence*

Is the address listed above within the attendance area of

*Current residence is the residence to which thestudent moved resulting in a change of schools.

the school listed above as the receiving schooi?Oes Oo

If the receiving school is a non-boundary school (i.e. private or charter school) what is the distance from the

current residence* to the receiving school?

of the current residence* to the receiving school.

Attach an explanation of the relevance

Previous Student Address City State

Name(s) of Parent(s)/Legal Guardian(s) Horne Phone Alternate Phone

E-mail of Parent(s)/Legal Guardian(s)

Date of Student's First Enrollment in 9'h Grade Date of Enrollment at Receiving School Date of First Attendance at Receiving School

School from Which Student Transferred (Sending School) City State

Enrolled at sending school from--;;--:- to--;;--,---------------Date Date

Record of Participation: List all interscholastic high school sport(s) in which the student participated, or intends to participate, at any level, Freshman, Sophomore, J.V. or Varsity (a try out would be considered participation):

Grade School Year Fall Winter Spring

glh

10'"

111

121

Has this student participated with (an) athletic team(s) at a high school other than the one listed as the sending school? DYes DNo If "yes", please list the school, city, state and sport(s)with season and year of the participation: Example: Central High School. Aurora. Wisconsin Soccer fall 2009. Basketball winter 09-10

School,City, State Sport(s) with Season(s) and Year(s)

School, City, State Sport(s) with Season(s) and Year(s)

Page 3 of3 Updated 7/19/2012Parent/Guardian and Student Certificate

To qualify as a bona fide change of residence for the purposes of a waiver of ineligibility due to transfer, one of the following cond ions must apply. Check the one that applies In this case:

0Full Family Move ·A permanent change in residence by the student and his/her entire family into the establishedattendance area of the high school to which the transfer is made. The new residence must be situated in a high schoolattendance area different from the prior residence. Examples of documentation that would be evidence of residence may include but are not limtted to the following: voter registration records, ecclesiastical membership records, vehicle registration, rent receipts, utility payments, mortgage documents or income tax documentation. (See UHSMBy-Laws Article 1, Section 9 as well as lnterps & Guidelines 1.9.1.H) Attach two separate pieces of evidence documenting the new residence.

0Divorce -Immediately subseauent to a Decree of Divorce, a student transfers to a new high school attendance area with a parent who has legal custody of that student. Any subsequent transfer even if to the residence of another parentwith legal or joint custody may not be considered a bona fide change in residence. (See UHSMBy-Laws Article 1, Section 9 as well as lnterps & Guidelines 1.9.1.1)

Attach a copy of the Divorce Decree and list the Civil Number:

Civil Number of Decree of Divorce. _

We certify that the information contained in this document is true and accurate to the best of our knowledge. We further certify that the documentation attached to this form is valid and accurate.

SignaJUre of Student Date Printed Name of Student

Signature of Father/Guardian Date Printed Name of Father/Guardian

Signature of Mother/Guardian Date Printed Name of Mother/Guardian

Attach a complete transcript of all classes beginning with the 9th grade.

Receiving School School Phone

E·mai/ of Receiving School Principal E-mail a/Receiving School Athletic Director

I independently certify that this students permanent residence is within the attendance area of the receiving school listed on this document and that this transfer meets the definition of a bona fide change in residence as described in the item checked above and in UHSAA By-laws Article 1, Section 9 as well as lnterps & Guidelines 1.9.1.F-G. I certify that this student Is enrolled and attending the receiving school listed on this document.

Signawre of Receiving School Principal Date Printed Name of Receiving School Principal

I am aware that the identified student is changing schools.

Sending School Signature of Sending School Principal Date

UHSAA OFFICE USE ONLY DWaiver of ineligibility approved, student fully eligible.

DWaiver of ineligibiltty denied, student not eligible.

D Waiver of ineligibility due to transfer approved, student ineligible due to:

Signature ofUHSAA Executive Director Date

Page I of3 Updated 7/19/2012

Utah High School Activities Association199 East 7200 SouthMidvale,Utah 84047Phone: 801-566-0681

Fax: 801-566-0633Web: www.uhsaa.org J Email:submit@uhsaa.org

Directions: Please type and fill all fields electronically, except signatures. Print the document (you cannot save the form on your

compUter), attach supporting documentation, collect all necessary signatures, and submit to the UHSAA office either by fax(801-566·0633) or mail.

Hardship Waiver RequestPlease be sure to include this cover page with the necessary documents listed below

• Your request will not be processed until all necessary documentation is submitted • A valid email address must be submitted

• Check the boxes after attaching necessary documents

• Allow 4-6 weeks for a ruling

Please fill out all fields, except signatures, electronically ·

D The attached two-page form completed with all signatures

D A copy of current transcriptD Documentation in support of the explanation of hardship (documentation must be from a

third party supporting the reason for hardship)

Student's Name Receiving School Date

Parent/Guardian Valid Email Address

Page 2 of3 Updated 7119/2012

Utah High School Activities AssociationPhone: 801-566-0681 Fax: 801-566-0633

Web: www.uhsaa.org IEmail: submit@uhsaa org

Form to Request a Waiver of Ineligibility Due to Transfer

Hardship Waiver Request

Transfer Student Information:

Name of Student Date of Birth Age09th Oro'h Orr th

Or2'hGrade in which Enrolled at Receiving School

Sending School (school from which student transferred) Receiving School (school to which the student transferred)

Address of Student's Current Residence City Zip

Date on which Student First Occupied the Current Residence

Is the address listed above within the attendance area of the school listed above as the receiving schooi?Oves 0No

Previous Address of Student City State

Name(s) of Parent(s)/Legal Guardian(s) Home Phone Alternate Phone

E-mail of Parent(s)/Legal Guardian(s)

Parent/Legal Guardian Address if Different from Student City State and Zip

Name of Person(s) with Whom Student Resides if Not Parent(s)/Legal Guardian(s) Relationship to Student

Date of Student's First Enrollment in 9"' Grade Date of Enrollment at Receiving School Date of First Attendance at Receiving School

School from Wl#ch Student Transferred (Sending School) City State

Enrolled at sending schoolrrom, to. ----------

Date Date

Record of Participation: List all interscholastic high school sport(s) in which the student participated at any level, Freshman, Sophomore, J.V. or Varsity (a try out would be considered participation):

Grade School Year Fall Winter Spring

glh

10'"

11'"

12'"

Has this student participated with (an) athletic team(s) at a high school other than the one listed as the sending school? Qves QNo If "yes", please list the school, city, state and sport(s) wtth season and year of the participation:

Example: Central High School. Aurora. Wisconsin Soccer fall 2009, Basketball winter 09-10 School, City, State Sport(s) with Season(s) and Year(s)

School, City, State Sport(s) with Season(s) and Year(s)

Page 3 of3 Updated 7/19/2012

Parent/Guardian and Student Certificate

To qualify as a hardship for the purposes of a waiver of ineligibility due to transfer, evidence which establishes an unforeseeable, unavoidable and uncorrectable act, condition or event which causes the imposition of a severe and non-athletic burden upon thestudent and/or his/her family shall be documented. (see UHSAA By-Laws Article 1 Section 9) Please explain the nature of the hardship below attach additional sheets if necessa and attach documentation in su ort of the ex Ianation.

Attach additional sheets if necessary We certify that the information contained in this document is true and accurate to the best of our knowledge. We further certify that the documentation attached to this form is valid and accurate.

Signature of Student Date Printed Name of Student

Signature of Father/Guardian Date Printed Name of Father/Guardian

Signature of Mother/Guardian Date Printed Name of Mother/Guardian

Attach a complete transcript of all classes beginning with the glh grade.

Receiving School Certificate

Receiving School School Phone

E-mail of Receiving School Principal E-mail of Receiving School Athletic Director

I certify that this student is enrolled and attending the receiving school listed on this document.

Signature of Receiving School Principal Date Printed Name of Receiving School Principal

Sending School Notification

I am aware that the identified student is changing schools.

Sending School Signature of Sending School Principal Date

UHSAA OFFICE USE ONLY 0 Waiver of ineligibility approved, student fully eligible.

0 Waiver of ineligibility denied, student not eligible.

0 Waiver of ineligibility due to transfer approved, student ineligible due to:

Signature ofUHSAA Executive Director Date

character)_Add ,r •:•:•==============-:------- Cap,

Timpview High School Extra-Curricular ActivitiesPre-Participation Physical and Parental Consent Form

PLEASE FILL OUTTHIS FORM IN BLUE OR BLACK INK ONLY. DO NOT FOLD. SCHOOL YEAR 20 4- 5

Mall characters: one #, one one

StudentName: c Gender: M F Age: _ School Year:

Sport(s): Date of Birth:---'--.L- Grade Level: 9 10 11 12

PARENT/GUARDIAN TELEPHONE NUMBERS INSURANCE INFORMATION

Name: Home: lriSurance Company:

Relationship:

Address:

Father (Work):

Mother (Work):

Name on Insurance Policy:

Group Plan/Policy Number:

City/State/Zip: Other:Person (different residence) to contact In case of eme"rg"e"'n"'c"y"w=h"e=-n· parent/guardiancannot be reached:

Name: Home: .L ...Ll _:_

Physician/Primary Care Center:

Hospital Preference:

- Insurance required for participation. Sport InsuranceRelationship: Other: ( ) information can be obtained through main office.

Participant & Parental Disclosure. Consent and Concussion concent Documents By signing below, I the parent or legal guardian of the above named student do:

0 Hereby consent to the above named student participating in the interscholastic athletic program at the school listed above. This consent includes travel to and from athletic contests and practice sessions.0 Further_ consent to treatment deemed necessary by health care providers designated by school authorities for any illness or injury resulting frOm hisfher athletic participation.0 Recognize that a rikconditions as: fractures, brain injuries, paralysis or even death.0 Acknowledge and give consent that a copy of this form will remain in the student's school. Iagree that if my student's health changes and would alter this evaluation, Iwill notify the school as soon as possible but within no longer than 10 days.0 Hereby acknowledge having received education including receiving written information regarding the signs, symptoms, and risks of sport related concussion.

ParentarGuardfan NameBy signing below I the student athlete acknowledge:

Parent or Guardian Signature Date

0 This application to compete in interscholastic athletics for the above school is entirely voluntary on my part and is made with the understanding that Ihave not violated any of the eligibility rules and regulations of the Utah High School Activities Association.0 My responsibility to report to my coaches and parent(s)fguardian(s) illness or injury Iexperience.0 Having received education including receiving written information regarding signs, symptoms, and risks of sport related concussion. Ialso acknowledge my responsibility to report to my coaches and parent(s)fguardian(s) any signs or symptoms of a concussion.

Signature of Student Date

THIS FORM MUST BE ON FILEATTHE MEMBER HIGH SCHOOL PRIOR TO PARTICIPATION.

QUESTIONARE

Yes No Yes NoI I I l 1. Have you had a medical Illness or ln]UJY since your last checkup or sports I l I I 8.

physical? I I I II I I I Do you have an ongoing or chronic illness? I l I l I I I I 2. Have you ever been hospitalized overnight? I I I I I I I I Have you ever had surgery? I I I I I l I I 3. Are you currently taking any prescription or nonprescription (over-the-counter) I l I I

medications or pills or using an inhaler? I I I I 9.I l I l Have you ever taken any supplements or vitamins to help you gain or lose I l I I 10.

weight or improve your performance? I I I II l I l 4. Do you have any allergies (for example, to pollen, medicine, food, or stinging I l I I

insects)? I I I I 11.

I l I l Have you ever had a rash or hives develop duringor after exercise? I l I lI I I I 5. Have you ever passed out during or after exercise? I I I II l I l Have you ever been dizzy during or after exercise? I I I I 12.I l I I Have you ever had chest pain during or after exercise? I I I II l I l Do you get tired more quickly than your friends do during exercise? I l I l 13.I l I I Have you ever had racing of your heart or skipped heartbeats? I l I lI l I l Have you had high blood pressure or high cholesterol? I l I lI I I l Have you ever been told you have a heart murmur? I l I l

I I I l Has any family member or relative died of heart problems or of sudden death I l I l

before age 50?I I I I Have you had a severe

viral infection (for example, myocarditis or mononucleosis) within the last month?

I) I I Has a physician ever denied or restricted your participation in sports for any

heart problems?I I I I 6. Do you have any current skin problems (for example, itching. rashes, acne,

warts, fungus,or blisters)?7. Record the dates of your most recent Immunizations (shots) for:

Have you ever had a head injuJY or concussion?Hav_e you ever been knocked out, become unconscious,or your memory? Have you ever had a seizure?Do you have frequent or severe headaches?Have you ever had numbness or tinglingIn your arms,hands, legs,or feet? Have you ever had a stinger,burner,or pinched nerve?Have you ever become Ill from exercisingIn the heat?Do you cough, wheeze,or have trouble breathing during or after activity?Do you have asthma?Do you have seasonal allergies that require medical treatment?Do you use any special protective or corrective equipment or devices that aren't usually used for your sport or position (for example, knee brace,special neck roll,foot orthotics, retainer on your teeth, hearing aid)? Have you had any problems with

your eyes or vision?Do you wear glasses,contacts,or protective eyewear? Have you ever had a sprain,strain, or swellingafter injury?Have you broken or fractured any bones or dislocated any joints?Have you had any other problems with pain or swelling in muscles, tendons,bones, or joints?/fyes, check appropriate box and explain below[ ] Head [ ] Elbow [ ] Hip[ ] Neck [ ] Forearm [ ] Thlgll[ ] Back [ ] Wrist [ ] Knee[ ] Chest [ ] Hand [ ] Shin/calf[ ] Shoulder [ ] Finger [ ] Ankle[ ] Upper arm [ ] FootDo you want to weigh more or less than you do now?Do you lose weight regularly to meet weight requirements for your sport?

Tetanus----Hepatitis B

Measles I I I l 15.

Chickenpox

Do you feel stressed out?

Explain Yes"

FEMAlES ONLY16. When was your first menstrualperiod? §' ; ::-=::;.

When was your most recent menstrual rlod?How much time do you usually have from the start of one period to the startof another? -cc=::-:-c:ccHow many periods have you had in the lastyear?c;::==What was the longest time between periods In the last year?

Doctor's Office Address InformationVlfAL STATISTICS

Height: Pulse Rate: Vision: Left /20 Right /20

Phone:

Weight:

% Body Fat (Opt):

Blood Pressure: ---''---- Corrected: ] Yes 1 No

Pupils: ] Equal ] Unequal

NORMM

GENERAL MEDICAL

ABNOR\1AL FINDINGS

I I Appearance

I I Eyes/Ears/Nose/Throat

I l Lymph Nodes

) Heart

I l Pulses

I l Lungs

I l Abdomen

I l Genitalia (males only}

I I Skin

MUSCULOSKELETAL

I I Neck

I I Back

I I Shoulder/arm

I I Elbow/forearm

I I Wrist/hand

I I Hip/Thigh

I l Knee

) Leg/Ankle

J Cleared

-------------------------------------,"S:;; ;;,;;,;;,.;;;,;;;;se•dexamlnatlo

PHI SICI<\N S COM \!lENTS

J Cleared with conditions (see comments)

] Not cleared (see comments)

---'-· - . -Signature of physician: Date:,_-,-,-- -,-,

c

ImPACT™(\

Dear Parent/Guardian,

Timpview High School is currently implementing an innovative progtatn for our student-athletes. Titis progtatn will assist our team physicians/athletic trainerS in evaluating and treating head injuries (e.g., concussion). In order to better manage concussions sustained by our student-athletes, we have acquired a software tool called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing). ImPACT is a computerized exam utilized in many professional, collegiate, and high school sports progtatns across the country to successfully diagnose and manage concussions. If an athlete is believed to have suffered a head

. injury during competition, ImPACT is nsed to help determine the severity of head injury and when the injuryhas fully healed

The computerized exam is given to athletes before beginning contact sport practice or competition. This non-invasive test is set up in "video-game" type format and takes about 15-20 minutes to complete. It is simple, and actually many athletes enjoy the challenge of taking the test. Essentially, the ImPACT test is a preseason physical of the brain. It tracks information such as memory, reaction time, speed, and concentration. It, however, is not an IQ test.

If a concussion is suspected, the athlete will be required to re-take the test. Both the preseason and post injury test data is given to a local doetor or, to help evaluate the injury. The information gathered can also be shared with your family doetor. The test data will enable these health professionals to determine when return to-play is appropriate and safe for the injured athlete. If an injury of this nature occurs to your child, you will be promptly contacted with all the details.

I wish to stress that the ImPACT testing procedures are non-invasive, and they pose no risks to your student athlete. We are excited to implement this progtatn given that it provides us the best available information for managing concussions and preventing potential brain damage that can occur with multiple concussions. The Timpview administration, coaching, and athletic training staffs are striving to keep your child's health arid safety at the forefront of the student athletic experience. Please return the attached page with the appropriate signatures. If you have any further questions regarding this progtatn please feel free to contact me at801-221-9720 orbenr@provo.edu. ·

Sincerely,

Ben RossTimpview Athletic Trainer

w w w. mpacttest.com

ConsentFonn

ImPACT™\,,

For use of the Immediate Post-Concussion Assessment and Cognitive Testing (ImPAC1)

I have read the attached information. I understand its contents. I have been given an opportunity to ask questions and all questions have been answered to my satisfaction. I

agree to participate in the ImPACT Concussion Management Program.

Signature of Athlete Date

Signature of Parent Date

www. mpacttest.com

IN HIGH SCHOOL SPORTS

A FACT SHEET FOR ATHLETES

What is a concussion?A concussion is a brain injury tha :• Is caused by a bump, blow, or jolt to the head

or body.• Can change the way your brain normally works.,• Can occur during practices or games in any sport

or recreational activity.• Can happen even if you haven't been knocked out.• Can be serious even if you've just been "dinged"

or "had your bell rung."

All concussions are serious. A concussion can affect your ability to do schoolwork and other activities (such

'07 as playing video games, working on a computer, studying, driving, or exercising). Most people with a

( ·. concussion get better, but it is important to give your brain time to heal.

What are the symptoms of a concussion?You can't s·ee a concussion, but you might.noticeone or more of the symptoms listed below or that you"don't feel right" soon after, a few days after, or even weeks after the injury.• Headache or "pressure" in head• Nausea or vomiting• Balance probl ms• Double or blurry vision• Bothered by.light or noise• Feeling sluggish, hazy, foggy, or groggy• Difficulty paying attention .• Memory problems• Confusion

What should I do if 1 think Ihave a concussion?• Tell your coaches and your parents. Never ignore a

bump or blow to the head even if you feel fine. Also, tell your coach right away if you think you have a concussion or if one of your teammates might have a concussioll';

• Get a medical check-up. A doctor or other healthcare professional can tell if you have a concussion and when it is OK to return to play.

• Give yourself time to get better. If you have a concussion, your brain needs time to heal. While your brain is still healing, you are much more likely to have another concussion. Repeat concussions can increase the time it takes for you to recover and may cause more damage to your brain. It is important to rest and not return to play until you get the OK from your health care professional that you are symptom-free.

How can I prevent a concussion?Every sport is different, but there are steps you can take to protect yourself. ·• Use the proper sports equipment, including personal

protective equipment. In order for equipment to protect you, it must be:. . . ..- The right equipment for the game, position, or acti;nty- Worn correctly and the correct size and fitc Used every time you play or practice

• Follow your coach's rules for safety and the rules of the sport.

• Practice good sportsmanship at all times.

It's better to miss one game than the whote season.

For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion.

June 2010 U.S. DEPARTMENT ,OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

a

IN HIGH SCHOOL SPORTS

A FACT SHEET FOR

What is a concussion?A concussion is a brain injury. Concussions are caused bya bump, blow, or jolt to the head or body. Even a "ding," "getting your bell rung," or what seems to be a mild bump or blow to the head can be serious.

What are the signs and symptoms?You can't see concussion. Signs and symptoms of concussioncan show up right after the injul)' or may not appear or be noticed until days after the injury. If your teen reports oneor more symptoms of concussion listed below, or if you notice the symptoms yourself, keep your teen out of play and seek medical attention right away.

• Headache or "pressure•

• Ensure that they follow their coaches' rules for safety and the rules of the sport.

• Encourage them to practice good sportsmanship at all times.

What should you do if you think your teen has a concussion?1. Keep your teen out of play. If your teen has a concussion,

herjhis brain needs time to heaL Don't let your teen return to play the day of the injury and until a healthcare professional, experienced in evaluating for concussion, says your teen is symptom-free and it's OK to return to play. A repeat concussion that occurs before the brainrecovers from·the first-usually within a short period of time (hours, days, or weeks)-can slow recovery or increase the Hkelihood of having long-term problems. In rare cases, repeat concussions can result in edema (brain swelling), permanent brain damage, and even death.

•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 mood, behavior,

or personality changes• Can't recall events prior

to hit or fall• Can't recall events after

hit or fall

in head• Nausea or vomiting• Balance problems or

dizziness• Double or bluny vision• Sensitivity to light

or noise• Feeting sluggish, hazy,

foggy, or groggy• Concentration or memory

problems• Confusion•Just not "feeling

right" or is "feeling down"

2. Seek medical attention right away. A health care profes- (sional experienced in evaluating for concussion will be ableto decide how serious the concussion is and when it is safe for your teen to return to sports.

3. Teach your teen that it's not smart to play with a concussion.Rest is key after a concussion. Sometimes athletes wronglybelieve that it shows strength and courage to play injured. Discourage others from pressuring injured athletes to play. Don't let your teen convince you that sjhe's "just fine."

4.Tell aU of your teen's coaches and the student's school nurse about ANY concussion.Coaches, school nurses, and other school staff should know if your teen has ever had a concussion. Your teen may need to limit activities while sjhe is recovering from a concussion. Things such as studying, driving, working on a computer, playing video games, or exercising may cause concussion symptoms to reappear or get worse. Talk to your health care professionaas well as your teen's coaches, school nurse, and teachers. If needed, they can help adjust

How can you help your teen prevent a concussion?Every sport is different, but there are steps your teens can taketo protect themselves from concussion and other injuries.• Make sure they wear the right protective equipment for

their activity. It should fit properly, be well maintained, and be worn consistently and correctly.

your teen's school activities during her/his recovery.

June 2010

It's better to miss one game than the

whole season.For more information and to order additional materials free-of-charge, visit: www.cdc.gov/Concussion. (

U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CENTERS FOR DISEASE CONTROL AND PREVENTION

April, 22, 2013

Dear Timpview Athlete' ,; Imputed E-Mail _

Prior to participating on a team from Timpview High School, athletes must provide the AthleticDepartment with current address, emergency contact, insurance, medical alert and health history information,(This is in addition to any form sent in to coaches). To expedite this process Timpview uses an online data entry system. This E-Mail address and information is required to be helped by our Sports Medicine Staff . The E-Mail address and password will be needed to record services before help is rendered, including taping. (Exception immediate injury)

To enter your information, visit www.swol123.net. The first time you visit the website you will need to enter your personal, School, or parents email address and click Get Password.

Joining SportsWareOnLineInstruction

Go to www.swol123.net.

Scroll to the middle of the screen and click the Join SportsWare button.

Enter your First Name, Last Name, Email address and the School ID and click the Send button.

Timpview ID: Timpview T -Birds

Your request to join SportsWare will then be sent to the Athletic Department for review.

Exam JeSpornWareOoline"'- <o; ;Wlnd6 !1jifniit EX q

o·o.., OO_·.w.r .S\ on !----- -I £\, 'Reset Password' button.

... nnrtc::W:llr,::io

Please Input vour Information to foln Sportsware

First Namn .----------,

Last Nama ======= EnmH =======:::

school ID =======CANCEL

\

ih.,. Your information has been saved.You wilt receive an e-mail when

your request has been accepted by the school

OK

Once your request is accepted you will receive an e-mail with the Subject "SportsWare request accepted".

Open the e-mail and click the _ www.swol123.net link to continue to S ortsWareOnLine.

1 i I StJbJect

Online Acce!>SOnline Access e-Mail J

New PasswordConfirm P11ssword ·

Setting Your Password

Subject "SportsWareOnLine PasswordRequest".

Open the e-mail and click on the link to reset your password. Enter your e-mail address, new password and click the

Updating Your Information {.ShJm.ld be up date.d...e.l!..< .flSJlL!).

-· --··--------,E.Yan:- 1\lldoni@ Adu. PUIWOI'Cl:

My Info: Update your address, emergency contact and insurance information.

My Info Med History Fonns Print

Med History: Complete a MedicalHistory questionnaire.

Forms: View/complete required paperwork. Note: SportsWare will also display "You have ? forms to complete/ download".

Print: Print My Info and Medical History

FormsYou have 0 form to complete/download

Thank you for your prompt help. If you have any questions, please contact the Athletic Director Mr. Hunter or myself at 801-221-9720 or e-mail us for assistance. mikeh@proyo,edu beor@porvo,edu .

Sincerely,

Ben Ross

Timpiew Athletic Trainer

Timpview High SchoolCode of Conduct

Courage Character & Class

Name (Print) Sport Year _1. Good citizenship as well as being respectful to teachers, officials and peers -

no profanity, illegal tactics, etc- is expected. Personal accountability is · paramount to success on and off the court.a. Do not show emotion at any call the referee or umpire makes. Coaches will speak

to the referee, if necessary.b. Encourage teammates to improve, don't yell at them or degrade them

during practices or games.2. Hazing is any action or situation, with or without the consent of the

participants, which recklessly, intentionally, or unintentionally endangers the mental, physical, or academic health or safety of an athlete.

3. You will be held responsible for your uniform and equipment. You will be required to pay for any lost or damaged items.

4. While involved in athletics, you must be in attendance the entire school day(or have a Doctors note) to participate (practice & games).

5. All participants must have the following items in order to tryout:i. A current physical on file (along with impact concussion testing consent)

11. Tryout check list (registerrnyathlete.com)111. Code of Conductiv. Anti Hazing pledge

6. Absolutely no tolerance for use or possession of drugs, alcohol, or tobacco. If you are present at an activity where a MIP is issued you are subject tosuspension from the team at your coaches' discretion. Understand that underage drinking is a crime and as a team, we will not be part of criminal acts.

7. Student athletes are expected to attend all classes each day in order to participate in practice, an event, game or activity. In addition, student athletes are expected to be prepared and on time for all practices, events, games and meetings.Absences will be checked daily and district/school attendance policy will be enforced. Absences can be excused by a parent and contacting the attendance office. Unexcused absences are reported to the coach. The following discipline options may then be exercised by the coach-

-Warning-Loss of game time/participation-Removed from the team

Road Trips8. Be on time for all team meetings and departure.9. Do not go anywhere without a coach knowing where you are going.10. Any lack of self-discipline on the road (failure to properly represent T.H.S.)

will result in disciplinary act at your coaches' discretion up to and including dismissal from the team.

Academics11. You will not be asked to give up academic responsibilities for athletics.12. There will be random, mandatory grade checks

Code of Ethics for Parents and Players13. Athletes and parents are all representatives ofTimpview High School. Your

demeanor and support reflects our standings.14. Timpview will not tolerate hostile, aggressive confrontations between a

parent, officials, coaches, or athletes. Violation ofthis policy may result in theathlete's dismissal from the team.

15. Athletes and parents agree to use the Grievance Procedure to express concernsand identify issues. This communication process helps maintain individual confidentiality and team unit. Violation of this confidentiality may result inthe dismissal of the athlete from the program

Grievance Procedure GuidelinesThe athlete is encouraged to talk to the coach when the athlete feels there is a problem.An athlete should approach her coach with her concerns following the grievance procedure. Every parent needs to know the appropriate communication process to express a concern during the season. A 24-hour period is required and enforced before any grievance is reported. Confronting a coach before, during or after a practice or game is not appropriate.

I. Athlete asks the coach at an appropriate time to discuss any issue2. The coach has 24 hours to respond3. Athlete and or parent/guardian and coach discuss problem4. Schedule a meeting with A.D. and or Vice Principal/Principal5. Meet with the Superintendent6. Meet with the Board of Trustees

I hereby consent to the previously named student participating in the interscholastic athletic program at Timpview High School. This consent included travel to and from athletic contest and practice sessions. I further consent to treatment deemed necessary by physicals designed by school authorities for any illness or injury resulting from his or her athletic participation. I also consent to follow Code of ethics for athletes and parents as well as the grievance procedure.

SIGNATURE OF PARENT/GUARDIAN DATE

I have read the team code of conduct, understand and agree to abide by the guidelines. My participation in interscholastic athletics for Timpview High School is entirely voluntary on my part, and with the understanding that I have not violated any of the eligibility rules and regulation of the state association.

SIGNATURE OF STUDENT -------------- DATE.

SAMPLEANTI-BULLYING, HARASSMENT, AND HAZING PLEDGE FOR STUDENTS & PARENTS

-----=====-=::-:------is committed to providing a safe, respectful, and positive

(NAME OF SCHOOl}educational experience for all its students. Behaviors that are potentially demeaning, abusive, illegal, or harmful to students are strictly prohibited at any time, both on and off school grounds,and will not be tolerated in any form.

BULLYING & HARASSMENT

Bullying or harassment include any physical act, gesture, or use of verbal, written or electronically communic::ated expression with the reasonable intention to cause any of the following:

Physical or emotional harm to another student

Damage to another student's property

Intimidate or threaten the safety of another student

Substantially interfere with a student's education or operation of the school

HAZING

Hazing is any activity involving someone joining or participating in a group that humiliates, degrades, abuses, or risks personal harm, regardless of the individual's willingness to participate. Hazing activities and behaviors include, but are not limited to:

Humiliation tacticsForced social isolationPhysical brutality such as whipping, beating, striking, branding, shocking, or placing a harmful substance on or in the body

Verbal or emotional abuse

Sexual abuse or misconductSleep deprivation, exposure to the elements, confinement in a small space, or any otheractivity that may adversely affect the mental or physical health of the victim

Abuse of tobacco, alcohol. drugs. or other prohibited substances

Forced or excessive consumption of food, liquids, alcoholic beverages, drugs, or any othersubstanceAny activity that induces, causes, or requires a student to perform a duty or task that is illegal

Hazing is abuse of power and unacceptable in any form or degree. Even seemingly harmless"traditions" or pranks can potentially go wrong, and off en escalate to riskier behaviors or activities.

BULLYING, HARASSMENT, & HAZING ARE STRICTLY PROHIBITED

Bullying, harassment, and hazing are disruptive to learning and extemely dangerous. offen resulting in devastating and unintended consequences for perpetrators, victims, families, schools, and the entire community. Any activities or behaviors associated with bullying, harassment, or hazing are strictly prohibited in any form.

DISCIPLINARY MEASURES

Violations af the school's code of conduct. anti-hazing policy.and/or this pledge will be disciplined accordingly.

MY PLEDGE

I. -----======-----• pledge to take a stand against bullying,

harassment,{NAME OF SlUDENT)

and hazing. I recognize that I am entitled to an education in a safe and respectful environment. and that any action or behavior !halthreatens my safely and well-being, as well as the safety and wel being

If I am a victim of bullying, harassment. or hazing. or if I witness or become aware of any buOying, harassment. or hazing, I will notify a parent. teacher. coach. or school staff member as soon as possible.

I understand that every allegation of bullying, harassment, or hazing will be taken sertously and thoroughly investigated. I am also aware that knowingly making false allegations is a serious offense and a violation of this pledge.

Ihave read this pledge and hereby agree to follow the standards set forth.

(SIGNAlURE OF STUDENT) IDATE)

I have read this pledge and hereby agree to set an example of the standards set forth.

{SIGNATURE OF PARENT/GUARDIAN) (DATE)

2

Timpview High SchoolCoaches Checklist

1) Review updated copy of the Thunderbird coaches' manual & Region 8Handbook

2) Season Schedule- Review contest limitations/guidelines/start date & first contest set by UHSAA

3) Sanction any contest involving 5 or more schools & multiple regions4) Tryout information & facilities scheduled on school's calendar5) Eligibility- Review all documents at registermyathlete.com

Review with all potential new athletes to the program Are they entering high school for the first time?In the past 12 months have they attended another high school (member or not)?In the past 12 months were they selected as a member of a high school team at another school?Are they currently enrolled at your school? If not where do they attend?Did they transfer to your school in the last 12 months? What was they date they enrolled?Are any foreign exchange 0-1) or international students (F-1)?Has proper paperwork for a transfer or hardship been completed/submitted?

6) Final Roster submitted to AD (Varsity Team photos- jersey number/position)7) Complete online rules clinic by deadline (UHSAA)8) Complete certification requirements (including assistants)9) Stipend allocation with administration, follow hiring procedures10) Transportation- Buses scheduled (Paperwork/Approval for out of state travel)11) Team Expectations shared and communicated12) Parent Meeting13) Review program goals/vision with assistant coaches14) Organized practiced schedule & review equipment & playing surface regularly15) Always schedule facilities & secure after use (Follow proper supervision)16) Review Emergency Action Plan w/athletic trainer, admin, & team17) Follow return to play (wfall injuries) protocol18) Review program budget regularly, follow purchasing procedures19) Fundraise as needed20) Attend monthly coaches meeting21) Review/check student athlete's grades22) Fulfill teaching responsibilities (hired on staff)23) Support all athletic programs and school sponsored activities24) Review out of season guidelines, and adhere to moratorium dates (UHSAA)25) Exit interviews with athletes and assistants at end of season26) Inventory check at end of season27) Evaluation meeting with Administration at end of season (Program recap)28) Recognition Banquet at end of season29) Off Season & summer camp/clinics organized and scheduled30) Be an example of good sportsmanship (Raise the Bar), honesty and ethics

Timpview High SchoolPRE-SEASON PARENT MEETING GOALS

PLANNING OBJECTIVES

• Introduce student activity participants, their parents, coaches, athletic trainer, and sponsors.

• Provide infonnation about activities, insurance, physicals, district policies, program philosophy, etc.

• Provide infonnation on state high school activities association rules and team rules.

• Provide specific guidelines, rules and consequences of rule violations.

• Provide infonnation concerning practice, game and tournament schedules.

• Warn student activity participants and their parents of the potential for physical injury.

• Give them a look at strategies.

• Promote importance of ongoing, honest communication.

• Create awareness about tobacco, alcohol and other drug use issues, ethics and sportsmanship and how they relate to sports and other activities.

• Involve parents in tobacco, alcohol and other drug education and prevention efforts.

• Develop a bond of mutual respect, cooperation, support and shared responsibility between student activity participants, their parents and the school.

• Involve parents in the development of student perfonners on and off the playing field.

c

(Coaching Evaluation Form

Ooa Spo' -----------------------

Number of years coaching in this assignment---------------------------Date: 1. Certification: Major Minor NFHSCEP Ooag First Aid/CPR2. Pre-Season Items:Submits administrative requirements in a timely manner

?? do we need the next part??

5· Exceptional 4·Above Average 3·Average 2. Below Average 1. Poor

1. Ooaching Responsibilitiesa. Provides leadership guidance and supervision to student athletes relating to

published team policiesb. Attends and participates in in-service meetings and other activities to inlprove

coaperformancec. Attends necessary meetings benefitting the Athletic Departmentd. Is competent concerning the management of equipment.Included are:Purchasing,

issue, collection, inventory and budge preparatione. IS cooperative in sharing facilitiesf. Shows self-control and poise in areas related to coaching responsibilitiesg. Operates the sport within the approved budgeth. Maintains care of the facilityi. Follows rules and regulations set forth by all governing agencies:UHSAA,

PSD, Region . 8 & TIISj. Uses proper administrative line of commandk Initiates programs and policies concerning injuries, medical attention and

emergenciesI. Holds pre-season parent meeting m. Holds award banquet or ceremony

2. Ooaga. Maintains appropriate sideline conduct.b. Provides proper supervision and administration oflocker rooms and buses c. Maintains individual team discipline and control

d. Emphasizes the value of competitive athleticS and teaches decision-making skills (e. Delegates authority while remaining accountable for such delegation f. Is prompt in meeting team for practices and gamesg. Monitors academic progress of each team memberh. Develops a well-organized practice schednlei.· Develops a season plan which ineludes philosophy, skill identification

and development evaluation.

3· Coaching Relationshipsa. Is cooperative in schednling and reschednling eventsb. Develops sound public relations.Cooperates With newspapers and prep magazine c. Promotes all sports in the athletic program and encourages their athletes to

Participate I

d. Develops rapport with administration, teachers and coaches

Score _

Atllleticnuector ture (Coach's Signature Date: _

*This signature inJ;ljcares t1Wt the coach ahs read and parlicipakdin this process.It does notindicateoomp/ete agrwment with all factors.71re coach may express disagreementin writing and attach SU£h dDcunummtion to this/onn.Ail copies mUst luwe this statement:ofdisagreenumt attached. Commenls, positive or negative may also be included. A copy of this signal document is to bedistributed to the coach, athleticdirector and principal.

(

(Have the following been completed? Add comments as needed.)

All Assistant Coaches have completed the 5 core elements needed for Coaches(back ground checlc, ooaching certification. concussion training, CPR and First Aide,)

Equipment Inventory

Season Summary Sheet

Team Awards Form

Banquet- Date of the--------

Post Season Evaluations and Recommendations of Assistant Coaches

Season Review with Athletic Director and Principal

COMMENTS:

(Head Coach Signature) (Date)

(Athletic Director Signature) (Dafe)

:.:;- ..

ASsistant coach Evaluation Form

Sport -'--'-'--'--'----'--H:ead Coach, _

Assistant Coach--- -----Positions----------'-'--

Needs

. This coach's signature.indicates thatcalJ phases. of the appraisal have been conducted with the full ·.knowledge of the coach.

Head Coach's Signature -------- · Date ---'---"-'-'"Assistant Coach's Signature----------'----,,--'- ----'-----' Athletic Directors Signature-- -------- '----,-----

Date._··--'-"Date -'--'--'----"-

Circle one:

Success: To be recommend for continued assignment

Needs Improvement: ·To be recommended for reassignment, provided an understanding can be reached in areaswhere improvement is suggest

Unsatisfactory: Not to be recommended for continued assignment

Timpview High School Athletic DepartmentSeason Summary

Please complete the following as soon as possible following the season for our athletic department permanent record file and return to Al Poland.

Sport _ Head Coach----------------------

Year-----------------------

#OF STIJDENTS STARTING THE SEASON (Alllevels)

#OF STIJDENTS ENDING THE SEASON

Team Awards FormAll State PlayersName Team Position

All Region Players

All State Academic Players Other Team Awards

Most Valuable Player -'----------------- --------------------

Offense Player Award------------------------------------------

Defense Player Award----------------------------------------

Season Record Form

S rt --------------------- H Coh

Year-

Region Finish State Finish

Date OpponentTimpview

ScoreOpponent

SCore

Region ReeordW L _ State Tournament Reeord

vs. ----------,---------Timpview Op nent

Season ReeordW L vs. -------------- Timpview Op nent

vs. ------------- Timpview Op nentvs.-------------- Timpview Op nent

613/2014 THS Athletic Program Evaluation Fall- StudentAhtlete - Google Forms

THS Athletic Program Evaluation- AthletePlease rate each of the following questions. 1 is low and 5 is high.

1. Did you enjoy their athletic experience?Mark only one oval.

1 2 3 4 5

000002. Do you feel that you became a better athlete in the sport in which you participated?

Mark only one oval.

1 2 3 4 5

000003. Did the coaches communicate well with you as an athlete?

Mark only one oval.

1 2 3 4 5

000004. Did the coaches have a good understanding of the sport?

Mark only one oval.

1 2 3 4 5

000005. Were the coaches motivating and encouraging?

Mark only one oval.

1 2 3 4 5

00000

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6/3/2014 THS Athletic Program Evaluation Fall·SrudentAhtlete- Google furms

6. Did the coaches give constructive criticism when appropriate?Mark only one oval.

1 2 3 4 5

( ) ( ) (J C:) (._)

7. Were practice times, game times and schedules well communicated in a timely manner?Mark only one oval.

1 2 3 4 5

(·· J (:::> C ) (_) C)8. Did the coach demonstrate good sportsmanship and respect toward officials and opponents?

Mark only one oval.

1 2 3 4 5

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9. Was the coach's public conduct at games respectable?Mark only one oval.

1 2 3 4 5

···\ Do you believe our team reached ifs full potential?Mark only one oval.

1 2 3 4 5

C) c.:J .- ') \ ......).. CJ

·;·; Which sport are you referring to in this survey?You may take the survey multiple times for various sports.Mark only one oval.

(J Football

( ") Volleyball

C) Soccer

(·::)( ')

Golf

Tennis

C)Cross Country

.) Other:

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6/3/2014 THSAtbletic Program Evaluation Fall- StudentAhtlete- oogle

12. Do you have any additional commenls and suggestions for improvement?

...........................................................................................................................................

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6/3/2014 THS Athletic Program Evaluation Fall- Parent- Google Forms

THS Athletic Program Evaluation

Please rate each of the following questions. 1 is low and 5 is high.

1. Did your son/daughter enjoy their athletic experience?Mark only one oval.

1 2 3 4 5

000002. Do you feel that your son/daughter became a better athlete in the sport in which he/she

participated?Mark only one oval.

1 2 3 4 5

000003. Did the coaches communicate well with your son/daughter as an athlete?

Mark only one oval.

1 2 3 4 5

000004. Did the coaches have a good understanding of the sport?

Mark only one oval.

1 2 3 4 5

000005. Were the coaches motivating and encouraging?

Mark only one oval.

1 2 3 4 5

00000

https://docs.google.com/a/provo.edu/forms/d/lsqHMC2iW3B4TNW1-805ZWzkBWWVtzdFAhfpbo2bVqT4/edit 1/3

6/3/2014 THS Athletic Program Evaluation FallParent- Google Forms

6. Did the coaches give constructive criticism when appropriate?Mark only one oval.

1 2 3 4 5

000007. Were practice times, game times and schedules well communicated in a timely manner?

Mark only one oval.

1 2 3 4 5

000008. Did the coach demonstrate good sportsmanship and respect toward officials and opponents?

Mark only one oval.

1 2 3 4 5

000009. Was the coach's public conduct at games respectable?

Mark only one oval.

1 2 3 4 5

0000010. Do you believe our team reached it's full potential?

Mark only one oval.

1 2 3 4 5

0000011. Which sport are you referring to in this survey?

You may take the survey multiple times for various sports.Mark only one oval.

0 Football

0 Volleyball

0 Soccer

0 Golf

0 Tennis

0 Cross Country

0 Other:

https://docs.google.com/a/provo.edu/forms/d/lsqHMC2iW3B4TNWI-805ZWzkBWWVtzdFAhfpbo2bVqT4/edit 2/3

6/.l/2014 THS Athletic Program Evaluation Fall- Parent- Google Forms

12. Do you have any additional comments and suggestions for improvement?

. google.cornlalprovo.edulforms/dllsqHMC2iW3B4TNWI-805ZWzkBWWVIzdFAhfpbo2bVqT4/edit

INVENTORY OF EQUIPMENT

a. Procedures for Inventory of Equipment

Head coaches will be responsible for the care, issuing and secure storage of athletic equipment and uniforms for their programs.

1) The head coach shall provide to the athletic administrator an Equipment-Uniform Check-Out Sheet showing the items issued to each team. member at the start of each season. All uniforms shall be marked for permanent identification.

2) Head coaches shall submit their athletic inventories to the athletic administrator within two weeks ofthe end of the season or at their post-season evaluation conference along with next year's budget request.

3) Once equipment and uniforms are no longer serviceable, the following procedure will be used for disposal:

a. Uniforms may be sold through the athletic office at a reduced price or discarded. b. Equipment may be sold or given away with a written liability release.c. Rejected football helmets shall be sawed in half before disposal.

4) During the season all equipment shall be secured in the proper storage areas after each contest or practice. Within the two-week inventory period at the season's end, all equipment and uniforms shall be cleaned and stored in the designated areas until the following year.

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2013-14 SCHOOL SPORTSMANSHIP AWARDFor the fourth year, the UHSAA calls on all member schools to "Raise-the-Bar and Earn-a-Star"by completing the School Sportsmanship Award criteria listed below. An online application will be

emailed to principals the first week of May and must be submitted by Friday, May 30, 2014.

Qualifying schools receive the2014 Gold Star for their UHSAA School Sportsmanship Banner, an Award Certificate, media recognition and UIAAA Director's Cup points. Schools will also be honored when they become a FIVE STAR PROGRAM.

To qualify for the School Sportsmanship Award and the 2014 STAR, schools must complete all of following items and submit the online app by May 30, 2014.

1. Schools must display their UHSAA School Sportsmanship Banner throughout the school year.

2. Student-athletes and their parents must sign the Sportsmanship Pledge on the UHSAA Tryout Checklist and coaches must address good sportsmanship in an orientation/meeting with players and parents.

3. Schools must have zero coach ejections for the year OR ejected coaches must complete the NFHS Course: Teaching and Modeling Behavior (nfhslearn.com/ as outlined in the UHSAA Handbook (p.53/. The AD should ask for a certificate of completion. If a coach is ejected a second time in a year,it will become a region disciplinary action and the Region Board of Managers shall fine the coach a $100.

4. Include the UHSAA policy "Do Rowdy Right" in your school sportsmanship policy and post the school's sportsmanship policy in a prominent location so students,parents,players and fans have a clear understanding of what will be expected and enforced at sporting events {template posted on uhsaa.org).

5. Promote and enforce the statewide UHSAA policy, "Do Rowdy Right: CHEER FOR YOUR TEAM and Not Against Your Opponent." Degrading,demeaning,negative cheers should be not be allowed to continue. What you permit,you promote. An assigned supervisor or coach should address issues that arise.

6. Sportsmanship shall be an agenda item on each of the Region Board of Managers scheduled meetings.Topics should include spectator/student behavior at region games,enforcing "Do Rowdy Right" andsupervision at sporting events. The Region Chair may ask the UHSAA to deny the Sportsmanship Award to a region school if that school has not followed-through with sportsmanship issues at their school.

7. Use the UHSAA sportsmanship announcements at home contests whenever anannouncer and PA system are available. The sportsmanship announcements are posted on the Sportsmanship page at uhsaa.org.

8. Have one or more of your teams participate in a service project to benefit a worthy cause.

9. Have two students participate in the. statewide UHSAA Student Leadership Conference: Dare to Lead, onFriday,June 20,2014 OR have students participate in a school,region/district leadership conference.

10. On the School Sportsmanship Award Application submit your most successful strategy,activity or "Best Practice" for promoting or enforcing sportsmanship and also one area of "Needs Improvement." A list of "Best Practices" will be posted on the Sportsmanship page at www.uhsaa.org.

UTAH IDGH SCHOOL ACTIVITIES ASSOCIATION· 199 EAST 7200 SOUTH-MIDVALE, UT 84047

PHONE (801) 566-0681 FAX (801) 566-0633

· 2011-2012 ACADEMIC AIL-STATE NOMINATION FORM

SPORT (PLEASE INDICATE BOYS OR GIRLS)

APPUCATION GUIDEUNES:

L By submitting this form the principal and coach certify that the candidate is a regular starter or performer on the varsity squad, has a minimum of 3.75 cumulative grade point average beginning with freshman year and meets all other criteria listed· on this form.

2. Transcript of credits must be attached. Applications lacking signatures or tnlnscripts will not be considered.

3. Only SENIORS ate eligible for this award.4. Selections will be final based on candidates' non-weighted cumulative GPA

by quarter and SAT/ACT scores if necessary.5. Any nu,mber ofindividuals from a given school may be nominated.6. This office is not responsible for applications lost in the mail or otherwise

not deli"ered to this office by 11:59 p.m. on the deadline date . Deadline dates are as follows:

September 6-Girls' Tennis, Boys' Golf September 13 - Girls' S<iccer, 1A Baseball September 20 - Q-oss CountryOctober 4-Volleyball October 11 -Football January 10-Drill Team

January 10-Swimmingtpiving, Wrestling January 17 -Girls' and Boys' Basketball ApriliO-Boys' Tennis, IA Boys' Golf April 10-Girls' GolfApri117-Baseball, Softball, Boys' SoccerApril 24- Track & Field

Name (asitappearsontnmscript) _

Name (as you want ittooppeoron award if selected) _

School Classification-----

Home Address _

City/State Zip Code _

Cumulative High School GPA (to 3 decimal points) ACT/SAT Score

_

Signatures: Principal _

Coach _

Athletic Director .:__

Utah High School Activities Association199 E 7200 So, Midvale, 84847, Ph 801-566'0681, Fax 801-566-0633

,._ ..

Determining Eligibility of Student-AthletesAccountability Model for Coaches, ADs & Principals

School sport Date _

HEAD COACH CHECKLIST:Attend training conducted by principal and athletic director to review rules, responsibilities and resources. The principal and AD should review the UHSAA eligibility requirements for student participation:

Students who previously established eligibility at another high school (i.e. attended another school, or tried out and were selected as a member of high school team) are NOT ELIGIBLEfdr participation in Association sponsored athletic activities (at any level) for twelve months from the first day of attendance at the new school unless the UHSAA approves a "Change of Residence" or "Hardship Waiver" application.

Review the UHSAA Calendar, Sport Specific Calendar and eligibility rules with the coaching staff. Adhere to UHSAA restrictions regarding start date, first contest, contest limitations, athletic period, "Three Weeks Prior," holiday moratoriums and the dead time period (dateson sport specific calendar). Verify that members of the coaching staff have completed the components required for certification (Background Check, First Aid, CPR, Concussion training and the "Fundamentals of Coaching" course). Verify that members of the coaching staff have read the current edition of the UHSAA Handbook.Attend the annual live UHSAA Rules Clinic for designated sport or complete the Online Rules Clinic and quiz.Prior to tryouts, hold an orientation meeting for potential players & parents to attend:• Distribute and discuss the concussion materials. Discuss physical examination Forms A & B.• Review UHSAA rules (siudent eligibility, Transfer Rule, limited team membership, sportsmanship, etc)• Read through "UHSAA Tryout Checklist Form." Collect the Tryout Checklist forms when completed. Meet with the AD to carefully review the completed UHSAA TryoufChecklist forms and determine the eligibility status of potentilMeet with the AD to verify scholastic eligibility & complete codes on TEAM ROSTER and submit to UHSAA.Prior to tryouts, meet with any potential athletes that are new to the program to identify their eligibility status:• Are they entering high school for the first time?• In the past 12 months have they attended another high school (member or non-member)?.• In the past 12 months were they selected ·as a member of a high school team at another school?• Are they currently enrolled at your school? If not, where do they attend? Are they a Co-Op student?• Did they transfer to your school in the last 12 months? What was the date they entered?• Are any foreign exchange (J-1) or international students (F-1)? Have them complete app & submit.• Students that attend an alternative. charter. private, virtual school or are home schooled may only

participate at ·the school within whose boundaries the parent or legal guardian reside or at the public school from which the student withdrew for the purpose of home schooling or attending a charter or private school.

Verify your players are full time students as defined by your school/district and are not in violation of theUHSAA Age Rule, Sport Season Rule, Attendance Rule or Amateur Rule.Verify your players are academically eligible. In the preceding grading period the student earned a minimum of a 2.0 GPA on a 4.0 scale or its equivalent; did not fail more than one subject.Prior to the first contest, review the "Limited Team Membership" Rule with players (after first contest date, players are not allowed to compete on any outside team in the same sport).

ATHLETIC DIRECTOR CHECKLIST:Verify that members of the coaching staff have completed the components required for certification (Background Check, First Aid, CPR, Concussion training and the "Fundamentals of Coaching" course). Conducted training with principal for coaches to review rules, responsibilities and resources.The principal and AD should review the UHSAA eligibility requirements for student participation:

Students who previously established eligibility at another high school (i.e. attended another school, or tried out and were selected as o member of high school team) are NOT ELIGIBLE for participation in Association sponsored athletic activities (at any level) for twelve months from the first day of attendance at the new school unless the UHSAA approves a "Change of Residence" or "Hardship Waiver" application.

Make sure coaches understand the eligibility rules. Review their responsibilities in determining eligibility. Meet with the coach to carefully review the completed UHSAA Tryout Checklist forms and determine the eligibility status of potential players (any questions marked "Yes" on the form require follow-up).Meet with the coach to verify scholastic eligibility & complete codes on TEAM ROSTER and submit to UHSAA. Meet with your principal regarding "Tryout Checklist" forms, scholastic eligibility & team roster for each designated sport and discuss any concerns or eligibility issues. May need to be taken to Region Board.After careful review and necessary follow-through, place completed Tryout forms securely on file at school. Submit the team roster on the required UHSAA excel template with the proper eligibility codes entered.The varsity roster should be emailed to varsityroster@uhsaa.org. It is the responsibility of the school to submit a new varsity roster if additions or changes are made to the varsity roster.If applicable, have the head coach submit a varsity team photo to teamphoto@uhsaa.org.

SCHOOL PRINCIPAL CHECKLISTVerify that members of the coaching staff have completed the components required for certification (Background Check, First Aid, CPR, Concussion training and the "Fundamentals of Coaching" course). Conduct a training for coaches to review rules, responsibilities and resources.The principal and AD should review the UHSAA eligibility requirements for student participation.See that head coach held an orientation with potential players and parents/guardians and reviewed the concussion materials, physical forms, UHSAA Tryout Checklist, student eligibility, and sportsmanship.See that head coach and athletic director carefully reviewed the completed UHSAA Tryout Checklist forms and did any necessary follow-up to verify eligibility status (any questions marked "Yes" require follow-up). See that head coach met with any new students to their program to determine their eligibility status. Confirm with coaches that only eligible athletes will be allowed to compete. On game day, Ineligible athletes may not be in uniform, warm-up with the team or be introduced. Ineligible players may practice.A student who transferred to a new school after establishing eligibility at another high school is not eligible to compete for twelve months of attendance at the new school unless the UHSAA has approved a Transfer Application (Change of Residence or Hardship) and notified the school.The charter, home, private, virtual school or alternative student may only participate in extracurricularactivities at the school within whose boundaries the student's custodial parent or legal guardian resides or at the public school from which the student withdrew for the purpose of home schooling or attending a charter or private school. Charter and private school students may only be eligible at a public school for sports or activities which are not available at their charter or private school._Foreign Exchange Student Eligibility Application must be approved for foreign exchange students (J-1 Visa). International Student Transfer Application must be approved for international students (F-1Visa).Under the Co-Op Rule, the UHSAA must receive the written approval of both principals and give approval.At Region Board of Managers meeting discuss eligibility.issues, transfers and sportsmanship.

Timpview Baseball·Emergency Action PlanTHS Baseball Field

Personnel• Ben Ross ATC

• Game: In dugout with team or on Gall from another THS field.• Practices: on practice field with team or in Training Room.

• BYU Athletic Training Students• Game: In dugout with team• Practices: on practice field with team or in Training Room.

• Team Physician• Game: on call• Practice: on call.

• Timpview Athletic Training Students• Games: in dugout with team.• Practices: on field with team or in the Training Room.

• Other (Coaches, EMS, Administrator, etc.)• Games: EMS will be summoned by calling 911.• Practice: EMS will be summoned by calling 911.

Role of Personnel during Emergency • ATC

• The athletic trainer will direct care and designate responsibilities during an emergency. Anyone dealing with an emergency situation will defer control to the person most qualified (for example, to a qualified physician or EMS).

Athletic Training Students• Assist with athlete as needed.• Get MD if needed.• Stand by to retrieve emergency equipment, direct EMS to the site, or

assist as necessary.• Team Physician

• On call• Other (Coaches, EMS, Administrator, etc.)

• Assist as requested and needed.• If a visiting team brings a certified athletic trainer, Timpview

personnel will assist as needed during any emergency. If the visiting team does not bring qualified medical staff, the Timpview ATC will direct care.

Location of communication Devices • Cell phone

• ATC will have a cell phone at competitions and practices. Coaches and others will have a cell phone.

• Standard telephone

Timpview Baseball Emergency Action Plan.Page 2

• If necessary, the nearest telephone is located in the training room. The ATC, BYU SAT, administration and janitorial staff will have keys to unlock the doors if needed.

Location and Directions for EMS• EMS

• Call 911: The person calling should wait for verification from dispatchthat Provo EMS has been contacted and is en route. If using school phone dial "9" (to get outside line) then dia191l.

• Directions• Address: 3570 North 650 East (Timpview Drive). The Baseball

field is south of the High School. From the intersection of 3230North and Timpview Drive just past the first house to your right heading north on Timpview Drive turn right heading east into a gated road that goes up past the city park around the back of the baseball field, and brings you onto the field by the dugouts.

Location of Emergency and Specialty Equioment • . AED-located on home dugout or at another THS field• Splint bag-located on home sideline or at another THS field.• Crutches-located in training room.• Spine board-located in training room.

Other Considerations • The ATC will have keys to the building doors and gates where EMS must

enter. Administrators and janitorial staff will also have building and gate keys.

• The athlete's contact and health insurance information is located in the team training kit on the sideline or coaches bag.

• A coach or athletic trainer will be sent to the ER if a guardian is not available.

Timpview Softball Emergency Action PlanTHS Softball Field

Personnel• Ben Ross ATC

• Game: In dugout with team or on call from another THS field.• Practices: on practice field with team or in Training Room.

• BYU Athletic Training Students• Game: In dugout with team• Practices: on practice field with team or in Training Room.

• Team Physician• Game: on call• Practice: on call.

• Timpview Athletic Training Students• Games: in dugout with team.• Practices: on field with team or in the Training Room.

Other (Coaches, EMS, Administrator, etc.)• Games: EMS will be summoned by calling 911.• Practice: EMS will be summoned by calling 911.

Role of Personnel during Emergency • ATC

• The athletic trainer will direct care and designate responsibilities dqring an emergency. Anyone dealing with an emergency situation will defer control to the person most qualified (for example, to a qualified physician or EMS).

• Athletic Training Students• Assist with athlete as needed.• Get MD if needed.• Stand by to retrieve emergency equipment, direct EMS to the site, or

assist as necessary.• Team Physician

• On callOther (Coaches, EMS, Administrator, etc.)

• Assist as requested and needed.• If a visiting team brings a certified athletic trainer, Timpview

personnel will assist as needed during any emergency. If the visiting team does not bring qualified medical staff, the Timpview ATC will direct care.

Location of communication Devices • Cell phone

• ATC will have a cell phone at competitions and practices. Coaches and others will have a cell.

• Standard telephone

'

Timpview Softball Emergency Action Plan. Page 2

• If necessary, the nearest telephone is located in the main office of the school which is across the street east of the softball field. Administration and janitorial staff will have keys to unlock the doors if n·eeded.

Location and Directions for EMS • EMS

• Call 9 I I:. The person calling should wait for verification from dispatch that Provo.EMS has been contacted and is en route. If nsing school

. phone dial "9" (to get outside line) then.dial91L If using main office phone push a number key to get an open line. ' ·

• Directions" .• Address: 3570 North 650 East (Timpview Drive): The Softball field is

directly across the stieet west of the front of the High·School.

. Location of Emerfiency and Specialty Equipment ' • · AED-located on home dugout or at another THS field

• · Splint bag·-l·ocated on home sideline or at (lnother THS field.• Crutches-l.ocated in training room..

- • · Spine board-located in training room.

Other Considerations .• The ATC will have keys to the building doors and gatewhere EMS must

enter. Administrato'"rs and janitorial staff will also nave building and gate keys. ·

• The athlete's contact and health insurance information is located in the team training kit on the sideline or coaches bag:

• A coach or athletic trainer will be sent to the ER if a guardian is·notavailable.

•

Timpview Boys & Girls Track Emergency Action PlanTHS Track

PersonnelBenRossATC

• Meet: at north end of track by high jump• Practices: on practice field with team or in Training Room.

• BYU Athletic Training Students• Meet: at north end of track by high jump• Practices: on practice field with team or in Training Room.

• Team Physician• Meets: on call• Practice: on call.

Timpview Athletic Training Students• Games: at north end oftrackbyhighjump• Practices: on field with team or in the Training Room.

• Other (Coaches, EMS, Administrator, etc.)• Games: EMS will be summoned by calling 911.• Practice: EMS will be summoned by calling 911.

Role of Personnel during Emergency ATC

• The athletic trainer will direct care and designate responsibilities during an emergency. Anyone dealing with an emergency situation will defer control to the person most qualified (for example, to a qualified physician or EMS).

• Athletic Training Students• Assist with athlete as needed.• Get MD if needed.• Stand by to retrieve emergency equipment, direct EMS to the site, or

assistas necessary. ·Team Physician

• On call• Other (Coaches, EMS, Administrator, etc.)

• Assist as requested and needed.• If a visiting team brings a certified athletic trainer, Timpview

personnel will assist as needed during any emergency. If the visiting team does not bring qualified medical staff, the Timpview ATC will direct care.

Location of communication Devices • Cell phone

• ATC will have a cell phone at competitions and practices. Coaches and others will have a cell phone on the field.

• Standard telephone

Timoview Track Emergency Action Plan.,Page 2 ·

• If necessary, the nearest telephone is located in the weight room office.The weight room door is located just north of the Public Restrooms. The ATC, coaches, administration, and janitorial staff will have keys

· to unlock the doors.

Location and Directions for EMS • EMS

• Call 911: The person calling should wait for verification from dispatch that Provo EMS has been contacted and is en route. If using school phone dial "9" (to get outside line) then dial911.

• Directions• Address: 3570 North 650 East (Timpview Drive). Go north of

Timpview High to the corner of Timpview Drive and Quail Drive. Drive east on Quail Drive to the second parking lot. Turn right into student parking lot. Drive to the southeast corner of the parking lot until you see an opening between the seminary building and the industrial arts building. Turn up into the driving range/upper parking lot and drive to the gate and ticket booth at the southeast corner of the driving range. From there you will see the track and the road that goes down to the field.

Location of Emergency and Specialty Equipment • AED--located on home sideline• Splint bag-located on home sideline

Crutches-located on home sideline or training room.• Spine board-located in training room.

Other Considerations • The ATC will have keys to the building doors and gates where EMS m

enter. Administrators and janitorial staff will also have building and g<: keys.

• The athlete's contact and health insurance information is located in tl·team training kit on the sideline.

• A coach or athletic trainer will be sent to the ER if a guardian is not available.

Timpview Boys & Girls Basketball and Volleyball Emergency Action PlanTHS Thunderdome

Personnel• Ben Ross ATC

• Games: on bench with team.• Practices: in gym with team or in Training Room.

• BYU Athletic Training Students• Games: on bench with team.• Practices: in gym with team or in Training Room.

• Team Physician• Games: on call; quite often in stands.• Practice: on call.

• Timpview Athletic Training Students• Games: on bench with team or in the stands behind the bench.• Practices: in gym with team or in the Training Room.

• Other (Coaches, EMS, Administrator, etc.)• Games: EMS will be summoned by calling 911.• Practice: EMS will be summoned by calling 911.

Role of Personnel during Emergency • ATC

• The athletic trainer will direct care and designate responsibilities during an emergency. Anyone dealing with an emergency situation will defer control to the person most qualified (for example, to a qualified physician or EMS).

• Athletic Training Students• Assist with athlete as needed.• Get MD if needed.• Stand by to retrieve emergency equipment, direct EMS to the site, or

assist as necessary.• Team Physician

• On call.. If in stands will assist when requested or if obviously needed without request.

• Other (Coaches, EMS, Administrator, etc.)• Assist as requested and needed.• If a visiting team brings a certified athletic trainer, Timpview

personnel will assist as needed during any emergency. If the visiting team does not bring qualified medical staff, the Timpview ATC will direct care.

Location of communication Devices • Cell phone

• ATC will have a cell phone at competitions and practices. Coaches and others will have a cell phone.

Timpview Thunderdome Emergency Action Plan.Page 2

• Standard telephone• If necessary, the nearest telephone is located in the coaches' offices.

The offices are located at the south end of the Thunderdome upper· level. The ATC, coaches, administration, and janitorial staff will have

keys to unlock the doors.• Walkie talkie

• Usually administer in the gym has a walkie talkie to communicate tostaff (varsity games only).

. Location and Directions for EMS • EMS on call.

• Call 911: The person calling should wait for verification from dispatch that Provo EMS has been contacted and is en route. If using school phone dial "9" (to get outside line) then dial 911.

• Directions• Address: 3570 North 650 East/(Timpview Drive). Go north of

Timpview High to the comer of Timpview Drive and Quail Drive. Drive east on Quail Drive to the second parking lot. Tum right into student parking lot. Drive to the southeast corner of the parking lot until you see an opening between the seminary building and the industrial arts building. Tum up into the driving range/upper parkhi lot and drive to the gate and ticket booth at the southeast comer o::·o i. driving range. Go through the gate and follow the road down the othe back doors of the Thunderdome. This is very close to the com the training room.

Location of Emergency and Specialty Equipment • AED-Iocated at home bench.• Splint bag-located at home bench or in training room.• Crutches-located in training room.• Spine board-located in training room.

Other Considerations • The ATC will have keys to the building doors and gates where EM '

enter. Administrators and janitorial staff will also have building anco keys.

• The athlete's contact and health instirance information is located in team training kit at the team bench.

• A coach or athletic trainer will be sent to the ER if a guardian is n•available.

Timpview Boys & Girls Soccer Emergency Action PlanTHS Football/Soccer Field

Personnel• Ben Ross ATC

• Games: on sideline with team.• Practices: onpractice field with team or in Training Room.

• BYU Athletic Training Students• Games: on sideline with team.• Practices: on practice field with team or in Training Room.

• Team Physician• Games: on call• Practice: on call.

• Timpview Athletic Training Students• Games: on sideline with team• Practices: on field with team or in the Training Room.

• Other (Coaches, EMS, Administrator, etc.)• Games: EMS will be summoned by calling 911.• Practice: EMS will be summoned by calling 91L

Role of Personnel during Emergency • ATC

• The athletic trainer will direct care and designate responsibilities during an emergency. Anyone dealing with an emergency situation will defer control to the person most qualified (for example, to a qualified physician or EMS).

• Athletic Training Students• Assist with athlete as needed.• To get MD if needed.• Stand by to retrieve emergency equipment, direct EMS to the site, or

assist as necessary.• Team Physician

• On call• Other (Coaches, EMS, Administrator, etc.)

• Assist as requested and needed.• If a visiting team brings a certified athletic trainer, Timpview

personnel will assist as needed during any emergency. If the visiting team does not bring qualified medical staff, the Timpview ATC will direct care.

Location of communication Devices • Cell phone

• ATC will have a cell phone at competitions and practices. Coaches and others will have a cell phone on the field.

• Standard telephone

Timpview Soccer Emergency Action Plan . Page 2

• If necessary, the nearest telephone is located in the weight room office.The weight room door is located just north of the Public Restrooms.The ATC, coaches, administration, and janitorial staff will have keys

· to unlock the doors.

Location and Directions for EMS • EMS

• Call 911: The person calling should wait for verification from dispatch that Provo EMS has been contacted and is en route. If using school phone dial "9" (to get outside l!ne) then dial911.

• Directions• Address: 3570 North 650 East (Timpview Drive). Go north of

Timpview High to the comer of Timpview Drive and Quail Drive. Drive east on Quail Drive to the second parking lot. Tum right into student parking lot. Drive to the southeast comer of the parking lot until you see an opening between the seminary building and the industrial arts building. Tum up into the driving range/upper parking lot and drive to the gate and ticket booth at the southeast comer of the driving range. From there you will see football/soccer field and the road that goes down to the field.

Location of Emergency and Specialty Equipment • AED--located on home sideline• Splint bag-located on home sideline• Crutches-located on home sideline or training room.• Spine board-located in training room.

Other Considerations • The ATC will have keys to the building doors and gates where EM.:..<

enter. Administrators and janitorial staff will also have building an;\keys.

• The athlete's contact and health insurance information is located in 'team training kit on the sideline.

• A coach or athletic trainer will be sent to the ER if a guardian is no'available.

Timpview Football Emergency Action PlanTHS Football Field

Personnel• Ben Ross ATC

• Games: on sideline with team.• Practices: on practice field with team or in Training Room.

• BYU Athletic Training Students• Games: on sideline with team.• Practices: on practice field with team or in Training Room.

• Dr. Mitch Larson-Team Physician• Games: on sideline with team; varsity only, on call for sophomore and

JV games.• Practice: on call.

• Rogan Taylor -Physical Therapist (Or a Therapist from his office.)• Games: on sideline with team. (Varsity games only; other games on

call.) ·• Practices: on call.

• TimpvieW Athletic Training Students• Games: on sideline with team• Practices: on field with team or in the Training Room.

• Other (Coaches, EMS, Administrator, etc.)• Games: EMS will be motioned onto the field when needed, Varsity

only. Other games'EMS will be summoned by calling 911.• Practice: EMS will be summoned by calling 911.

Role of Personnel during Emergency • ATC

• The athletic trainer will direct care and designate responsibilities during an emergency. Anyone dealing with an emergency situation will defer control to the person most qualified (for example, to a qualified physician or EMS).

• Athletic Training Students• Assist with athlete as needed.• To get MD if needed.• Stand by to retrieve emergency equipment, direct EMS to the site, or

assist as necessary.• Team Physician

• The MD will come onto the field and stand by or assist if their help is needed or requested. '

• Other (Coaches, EMS, Administrator, etc.)• ' Assist as requested and needed.• If a visiting team brings a certified athletic trainer, Timpview

personnel will assist as needed during any emergency. If the visiting team does not bring qualified medical staff, the Timpview ATC will

Timnview Football Emergency Action Plan . Page 2

direct care.

Location of communication Devices • Cell phone

• ATC will have a cell phone at competitions and practices. CoachWong and others will have a cell phone on the field.

• Standard telephone• If necessary, the nearest telephone is located in the weight room office.

The weight room door is located just north of the Public Restrooms. The ATC, football coaches, administration, and janitorial staff will have keys to unlock the doors.

• Walkie talkie• Usually administer on sideline has a walkie talkie to communicate to

staff (varsity games only).

Location and Directions for EMS • EMS on location for varsity games only.

• EMS parks at the northeast comer of the track/field.• For all other games call911. The person calling should wait for verification

from dispatch that Provo EMS has been contacted and is en route. If using school phone dial "9" (to get outside line) then dial 911.

• Directions• Address: 3570 North 650 East (Timpview Drive). Go north of

Timpview High to the comer ofTimpview Drive and Quail Drive Drive east on Quail Drive to the second parking lot. Tum right in student parking lot. Drive to the southeast corner of the parking ' until you see an opening between the seminary building and the industrial arts building. Tum up into the driving range/upper pa• lot and drive to the gate and ticket booth at the southeast corner driving range. From there you will see football field and the rot goes down to the field.

Location of Emergency and Specialty Equipment• AED-Iocated on home sideline• Splint bag-located on home sideline• Crutches-located on home sideline• Spine board-located on home sideline or training room

Other Considerations • The ATC will have keys to the building doors and gates where E:rt

enter. Administrators and janitorial staff will also have building a keys.

• The athlete's contact and health insurance information is located team training kit on the sideline.

• A coach or athletic trainer will be sent to the ER if a guardian is available.

cUTAH MODEL POLICY (adapted from NFBS.poliey)

Management of Sports-Related ConcussionsModel Local Education Agency Concussion and Head Injury Policy

Medical management of sports-related concussion continues to evolve. Recently, there has been a significant amount of new research gsports-relatedLocal Education Agency (hereafter "LEA1has established this protocol to provide education about concussion for coaches,school personnel, parents, and students.LEAs includelocal boards of education, local charter hoards,as wellas miscellaneous special programs. This protocol outlines procedures for staffto follow in m;maging concussions, and outlines school policy as it pertainS toreturn to play issues following a concussion.

LEA seeks to provide a safe return to activity for allstudents following any injmy,hut particularly after a concnssion.ln order to effeclively and coiiSiSb!ntlymana;e these injuries,procedures have been developed to aid in insuring that concussed students are identified.treated and referred appropriately,receiveappropriate follow-up medical care dnringtheschOOl dayand are tUlly teemleJed prior toreturningtoactivity.

County or State Health Department employees and Physical Education specialists shan review this protocol annually.Any changes or modifications will he reviewed and given to athletic depat1mellt stalf.induding coaches and other appropriate school personnel in Writing.

All appropriate staff shall attend a yearly in-service meetiug in Which procedures for managingsportiugevent-related concussions are discussed. (Local education agencies should note that the Utah State Board of Education passed R277-614 on August 6,2011. The Rule directs LEAs to develop a policy nsingthis,the USOEfRisk Management's model policy, to provide training to appropriate personnel, to provide notice to parents of the LEA's policy,topost a copy of the LEA's policy, and to nse model parent acknowledgement and pennission forms.

RecoguiUon of Concussion

What is a concussion? A concussion is type of traumatic brain injury that interferes with normal function of the brain. It occurs when the brain is rocked back and forth ortwisted inside the slrull as a result of a blow to the head or body.Whatmay appear to he only a mild jolt or blow to the head or body can result in a concussion. A conrussion can oa:urevenIfa player or stUdent in an activityis not knocked out or loses consdousness. (NFHS "Suggested Guidelines for Management of Concussion in Sports.1

Common sigus and symptoms of sports-related

concussion. Signs (observed by others): · ·

• Student appears dazed or stunned• Confusion• Forgets plays• Unsure about game, score, opponent• Moves clumsily (altered coordination)• Balance problems · (• Personality change

(• Responds slowly to questions• Forgets events prior to hit• Forgets events after the hit• Loss of consciousness (imy duration)

Symptoms (reported by student):

• Headache·• Fatigue• Nausea orvomiting• Double vision, blurry vision• Sensitive to light or noise• Feels sluggish• Feels "foggy".• · Problems concentrating• Problems remembering

These signs and symptoms following a Witnessed or suspected blow to the head or body are indicative of probable concussion. Any student who exhibits signs, symptoms, or behaviors consistent With a concussion (such as loss of consciousness, headache,dizziness,confusion,or balance problems) shall be immediately removed from the contest, game, or practice and shall not return to play until cleared by an appropriate health care professional. ·

Management and Referral Guidelines for All SlatJ

1. The following situations indicate a medical emergency and require activation of the Emergency Medical

System:

•!• Any student With a witnessed loss of consciousness (LOC) of any duration should be spine boarded and transported immediately to nearest emergency department via emergency vehicle.

•!• Any student who has symptoms of a concussion, and who is not stable (i.e., condition is worsening}, is to be transported immediately to the nearest emergency department via emergency vehicle.

•!• A student who exhibits any of the following symptoms should be transiJOrted immediately to the nearest emergency department, via emergency vehicle.

Deterioration of neurological functionDecreasing level of consciousnessDecrease or irregularity in respirations

· . Any signs or symptoms of associated injuries, spine or skull fracture, or bleedingMental status changes: lethargy, difficulty maintaining arousal, confusion or agitationSeizure activity

2. A student who is symptomatic but stable,may be transported by his or her parents.The parents should be advised to contact the student's primary care provider, or seek care at the nearest emergency department, on the day of the injury.

Guidelines and Procedures for Coaches and Teachers Supervising Contests and Games:

RECOGNIZE, REMOVE, REFER

( Recognize concussion

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1. All educators and agents of the LEA should become familiar with the signs and symptoms of concussion that are described above. .. · . .( 2. Educators adtraumatic head injuries,consistent with the employees' responsibilities for supervising students and .athletes.

Remove from activit;y

Any student who exhibits signs,symptoms, or behaviors consistent with a concussion (such as loss of · consciousness,headache, dizziness;confusion, or ba)ance problems shall be immediately removed from the sporting event and shall not return to play until cleared by an appropriate health care professional.

When in doubt, sit 'em out

Refer the athlete/student for medical evaluation

1. The agent of the LEA is responsible for notifying the student's parent(s) of the injury.a. Contact the parent(s) to inform a parent of the injury.Depending on theinjury,either

anemergency vehicle will transport or parent(s) will pick the student up at the event

fortransport (see Section II).

b. A medical evaluation is required before returning to play.2. In the event that a student's parent(s) cannot be reached,and the student is able to be sent home

(rather than directly to MD):• The LEA's agent should insure that the student will be with a responsible individual, who

is capable of monitoring the student and understanding the home care instructions, before · allowing the student to go home.

• The LEA agent should continue efforts to reach a parent• If there is any question about the status of the student, or if the student cannot be monitored

appropriately, the student should be referred to an Emergency Department for evaluation.An LEA's agent should accompany the student and remain with the student until a parent arrives.

• The LEA's agent shall provide for supervision of other students for whom he or she is·responsible when accompanying the injured student

Students with suspectedhead injuriesshould not be permitted to drive home.

3. LEA agents should seek assistance from the host site certified athletic trainer (ATC) or team physician, if available, at an away contest if the injury occurs at a formal athletic contest ·

Return to Play (RTP) Proeednres Mter Concussion

1. Return to activity and play is a medical decision.The student must meet all of the following criteria in order to progress to activity:

a. Asymptomatic at rest and with exertion (including mental exertion in school) ANDb. have written clearancefrom the student's primary care provider or concussion specialist

(student must be cleared for progression to activity by a physician other than an Emergency Room physician,if diagnosed with a concussion).

2. Once the above criteria are met, the student will be progressed back to foilactivity following the step wise process detailed below.(This progression must be closely supervised by an LEA agent If your school does not have an athletic trainer, then the coach must have a very specific plan to follow as directed by the athlete's physician).

/ 3. Progression is individualized,and will be determined on a case-by-case hasis. Factors that may affect the rate ofprogression include:previous history of concussion,duration and type of symptoms, age of

the student, and sport/activity in which the student participates.An athlete/student with a prior .history of concussion, one who has had an extended duration of symptoms, or one who is participating (in a collision or contact sport may be progressed more slowly.

4. Stepwise progression as described below:

. Step 1.Complete cognitive-rest This may include staying home from school or limiting school hours (and studying) for several days.Activities requiring concentration and attention may worsen symptoms and delay recovery.Step 2.Return to school full·time.Step 3.Light exercise.This step cannot begin until the student is no longer having conCussion symptomsand is cleared by a physician for further activity.At this point the athlete may begin walking or riding anexercise bike.No weight lifting.Step 4.Running in the gym or on the field.No helmet or other equipmentStep 5.Non-contact training drills in full equipment Weight training can begin.Step 6. Full contact practice or training.Step 7.Play ingame. Must be cleared by physician before returning to play.

• The student should spend 1to 2 days at each step before advancing to the next If post concussion symptoms occur at any step, student must stop the activity and the treating physician must be contacted. Depending upon the specific type and severity of thesymptoms. thestudent may be told to restfor 24 hours and then resume activityat a level one step below where he or she was at when the symptoms occurred.This resumption of activity could be considerably simplified for a student injured during recess compared to a student injured at a game or formal practice.

Potential Problem Areas

While current Utah law designates that a student may be returned to play by "an appropriate health care (provider" it is the prerogative of each LEA to designate the credentials Df the pi'OIIiders from whDm theywill accept clearance.This is a veryimportantdecisioo and shooJd be made after careful consideration by the athletic dir'!!Ctor, prindpal.superintendent,teadler (elementary),and parent(s).Theschool district's liability carrier may alsD be consulted.

For students injured during fDrmal competitiDDS,serii)US consideratiDn must also be given as to what the school will dD in the case where an athlete is dearly stillhaving roncussioo symptoms,yet given return to play clearance by a health care provider.A fDrmal policy should be developed which designates a specific individual{preferably an expert in the field of conc:ussion management- typically a physician w neuropsychDIDgist) who shall evaluate the athleteand malrethe:final decisiDn regarding returnto play.

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··..;. ·_.:': .· ..• ...

STUDENT INJURY REPORT FORM INSTRUCTIONS cThis form is to be completed immediateiY..f911owing the occurrence of any Injury that is severeenough to: · · .

a...cause the loss of orie-half.day:or..iriore:of school, · . . .·.b. Warrant medical attention and treatment (l:e. school nurse, M.D., E.R., etc.), and/or c. Require reporting accofdihg to SchooiDistrict poncy. ·

Item#1-23-4

5-1011

12

Self explanatory. ..District and school numbers are found in the Utah School Directory published.by the State Office of Education.Sel'e.xplanatory.Do not send the form until you have filled in days missed. If student is going to be absent for anextended period of time, use parent's estimate. If no schoolis missed, days absent is "a". Check and com.plete .rut that apply. By marking either #6 or #10 specify whether or not studentreceived medical attention and list·diagnosis if known. Listitle code (from the codes that follow)and name of person(s) who perform first aid and who notify parents.

· .. · · · · Title Codes

1. Advisor/Counselor2. ·Assistant Principal3. Bus Driver4. Coach5. Paramedics/EMT6. Playground Supervisor7. Principal

8. School Nurse9. Secretary/Office Aid

10. Substitute Teacher11. Teacher (excluding Coach)12. Teacher's/Piayground Aid13. Other14. Trainer

13

14

15·1617

18-192021

Of the injuries the child sustained, Jist whichever is the most severe in the box labeled "more severe" (even if you consider the Injury to be minor). The other box is used only if there is more than one injury to the chUd.List the area affected in the "more severe" box that corresponds to the injury listed in the "moresevere• box in #13. Do the same for the less severe box. Self explanatory.Describe surface over which injury occurred (i.e.surface upon which child was standing, running, or playing).Self explanatory.If you check no to first question, leave the others blank.Briefly describe specifically how the incident happened. If there were wilnesses, please list names at the end. If additional space is needed, continue on anolher sheet of paper and altach.

If you have questions or need sell-addressed envelopes or additional forms, please contact the office listed below.

Retain original in school; send copy to School District (according to lime frame specified byDistrict policy); and one copy to:

UTAH DEPARTMENT OF HEALTH VIOLENCE & INJURY PREVENTION PROGRAM

P.O. BOX 142106SALT LAKE CITY, UTAH 84114-2106

Telephone: (801) 538-6141

Copies for the Department of Heallh may be retained and submitted on a monthly basis in the self-addressed envelope or to the address above.

Revised 4/2007

HEAD TRUNK EXTREI\.llTIESI.Chin/Cheek 6. Neck/Throat . 10.Stomach IS. Genitalia I9.Ankle 24.Hand/Wrist

More Severe l.Ear 7. Nose 11.Back; I6,1ntemal 20,Ann 2S.Knee3.Eye 8. Head I2, Buttocks · I7.Pelvisllllp 21.Eibow 26.Leg

Less Severe I !·Forehead 9.Toothlfeetb :14 II r18. Shoulder ;· 27.Toe

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STUDENT. INJURY REPORT FORM UTAH DEPARTMENT OF HEALTH

VIOLENCE &. INJURY PREVENllON PROGRAMThis form Is to be completed lmmedkdely following the occurunceof DJIY injury that is severe enough to: (a) cizuse the loss of one-half day or more of school,(b) worrDJit medlctJ] attention lllfd treatment t'i.e. school nurse, M.D., ER., elc.l Qlld/or require reporting accordb!g to School District pollcf· Add/donal instructions on back.

l. Child's Name s. Date of Birth I I 8. Date oflnjury l l( Parent's Name m-;--day yr- mo day yr

-J. District Name4. School Name

-- -----------'#,#• '-----_

6. Grade,; Time oflnjury ·· ----()

9. ( ) Male. ( ) Female10. Fatal ( ) Yes ( ) No

l no absence record letter "a".

<) I e) 2 112·3 f) lfmore than 3 days, then specify H days

12. ACTION TAKEN: PLEASE CHECK AND COMPLETE ALL THAT APPLY.TIME• BY WHOM (Iitle codes on back) Specify name

1.D Fint aid administered2.D Parent or guardian notified3.D Unable to cOntact parent/guardian4. D Remained in or returned to class

S.D Sent/taken home

----(}am ( )pm---- (}am ( )pm

()am ( )pm

Specify name _: _

·. 9.D Called 911

IO. Seen by M.D-!E-R.Jbealth' Care p_rovider/hospitaUetc. Diagnosis:--------- 6.D Parents deemed no medical action necessa_ry

7.D Checked by school nurse

8.D Checked b EMT on staff

. 11.D HcisPitilized ,'t specify length:·----------

I2.D Re:'t cted Specify length:------13.o·other-s eci

I3. NATURE OF INJURY: Listtheln'uries/.•:umntoms incurred. tRecord# in boxes atJeft_i

D More Severe

D Less Severe

I.Abrasion/Scrape2.BumpiBruiseJContusion3.BurnlScald4.Concussion (possible)

S.Cut/Laceration6. Dislocation (possible)7.Fracture/Broken (poulble)8. Loss of Consciousness

·9. No Pulse/Heartbeat10. Not Breathing11.Palnll'enderness Only i2.PuDcture

13.Shortne.u of Breath14.SprainJStraintrearIS. .Swellingllnflammation16.Other

I4. AREA AFFECTED: List orea o.ffecJedfor each injury/symptom code lo/Jed in 13 above. (Record# in boxes at/eft)

D D

IS. CONTRIBUTING FACTOR: List facJor whlc/r mtiP have led to the inlu.n1.(Record# In box at left.II.Animal bite (dog bite etc.)2. Collision with object or person3.Compression/Pinch4. Contact witli.equipment (shop, P.E.)

S.Contact with fire, hot liquid or hot object6.Drug, alcohol or other iubstince7.Fall8. Foreign body/Object

9.Hit with thrown_ object10, Overexertlonll'wlsted11.Seizure disorder12.Tripped/Slipped

13.Unknown14.Weapon (gun, knife, etc.)

SpecifyIS.Other

which in u occurred. 'Record# in box at le4.Athletic practice sessionS. Before school6 Ill han

7.Class time (exclude PE)8.Field trip

·i n

10. Lunch11.Lunch recess12. Recess

13.P.E. classI4, Other

occurred. "Record # in box at I t4. Dirt 7. Lawn/Grass IO.Synthetic surface 12.Wood(waxed)S.Gravel 8.Mats (I.e.Tartan surface) 13.Other6 I·· h"

I8. LOCATION: List JocatWn at which iniun1 occurred. (Record# in box at Jefi.JI.Athletic field2.AuditoriumRtlultipurpose3.Bus loading area4.Classroom

D 3.Bicycling

S.Corridorillall (exclude stairs)6. Doorway7. Gymnasium8.Lab (Home Ec., Chern, etc.)

9.Lulichro'om/Kitchen10.Playground/Piayfield11.School bus/Public bus12.Shop (Industrial Arts, etc.)

I3.Sidewalk/Stain/Ramp · ··14.Street/Driveway/Parking AreaIS.Restroom/LavatoryI6.Other

7.Fighting 13.Playing on bars8.Flag/Touch football (monkey bai"Sibig toy/etc.)

I8.Sliding19.Sliding on Ice

24.Throwing rocksr snowballs

9. Football 14.Riding 20.Sittingo

2S.Track and field 29.Other4.Clauroom activityS.Ciimbing6 Dod ball/War all

10.Gymnastics/Tumbling tl.Jumping12 Ki kball

1S.RunningI6, Roughhousing17 tin u ovin "'

21, Soccer22.Standing23 In in

26.Volleyball27.Walking28 W tlin

20. EQUIPMENT:Was equipment or apparatus Involved in Injury? DYes DNo IF YES (a) Did.equipment appear to be used appropriately? DYes DNo

Specify equipment ---------------'------- (b) Was there any apparent malfunction or equipment? DYes D No

21. DESCRIPTION: Describe specifically how the injury happened:-------------------------------------------

( Title CodeSignature of Penon Making Report

23. - --- - .. P.rincipal's Signature

=------

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Timpview All Sports CampsRELEASE AUTHORIZATION:EMERGENCY TREATMENT

I understand that I am required to maintain and carry accidental medical insurancecoverage for the participant listed on this application and I verify that the coverage information attachedherewith is accurate and true. This required coverage will be in full effect while participating in theTimpview All Sports Camps. In case of any emergency, T authorize the staff ofTimpview All SportsCamps to obtain whatever medical transport and/or treatment is necessary for the welfare of the participant listed on this application. All charges and fees incurred in the rendering of transport of treatment is my responsibility.ram the authorized parent/guardian of this minor (Name)-,,--------------- And I am legally authorized to sign this release on their behalf.

(Parent/Guardian Signature) (Date)

(Insurance Carrier) (Policy Number)

WAVIER OF LIABILITY, ASSUMPTION OF RISK, AND INDEMNITY AGREEMENT

WAIVER: In consideration of being able to participate in any way in the Timpview All Sports Camps. I, for myself, my heirs, personal representatives or assigns, do hereby release, discharge, waive, and convenant not to sue the Provo School District, doing business at the Timpview All Sports Camps, its coaches and employees, and agents resulting in personal injury, accidents or illnesses (including death) and property loss arising from, but not limited to participation in the Tirnpview All Sports Camps. Assumption of Risks: Participation in the Tirnpview All Sports Camps carries with it certain inherent risks that cannot be eliminated regardless of the care taken to avoid injuries. The specific risks range fromI) minor injuries such as scratches, bruises and sprains to 2) major injuries such as eye injury or loss of sight, joint or back injuries, heart attacks, and concussions to 3) catastrophic injuries including paralysis and death.I have read the previous paragraph and I know, understand, and appreciate the repercussions of these and other risks inherent in Timpview All Sports Camp.s I hereby assert the participation is voluntary and that I knowingly assume all such risks.Location: This wavier assumption of risk and indemnity is in effect at anytime myself, the participant, are present on campus or in any location associated with the Timpview All Sports Camps.Indemnification and Hold Harmless: I also agree to INDEMNIFY and HOLD Provo School District and Timpview All Sports Camps HARMLESS from any and all claims, actions, suits, procedures, costs, expenses, damages, and liabilities, including attorneys fees brought as a result of involvement with the camp and to reimburse them for any such expenses incurred.Severability: The undersigned further expressly agrees that the foregoing wavier and assumption of risks agreement is intended to be as broad and inclusive as is permitted by the law of the State of Utah and that if any portion thereof is held invalid, it is agreed that the balance shall, notwithstanding, continue in full legal force and effect.Acknowledge of Understanding: I have read this wavier ofliability, assumption of risk, and indemnity agreement, fully understand it's tenns, and understand that I am giving up substantial rights, including my right to sue. I acknowledge that I am signing the agreement freely and voluntarily and my signature is a complete and unconditional release of all liability to the greatest extent of the law.

(Parent/Guardian Signature) (Date)

(Athlete's Name) (Which Sport Camp)(_

C.

ASSUMPTION OF RISK, RELEASE OF LIABILITY, AND CONSENT TO MEDICAL TREATMENT

As a condition of my/my child's participation in the Timpview Football Camp, and in consideration for the privileges that

· ( - 00me from participation in that camp which may indude instruction, use of facilities and equipment, and other services. ,Jrovided by Timpview Football, I herepy agree for myself and/or for my minor child as follows:

I. Irecognize and understand the football camp is a coaches' camp offered and operated by Timpview High School Football. The Football Camp is not a mandatory activity or a necessary part of "try-outs" and participation in the camp does not have any bearing on a player making the team.

2. Irecognize that the football camp will involve various activities that may include, put are not limited to, instruction,

conditioning,practices, scrimmages, meals, and travel to and from the football camp or camp activities.3. Irecognize that there are certain inherent risks of harm to me and others associated with my participation in

the football camp and camp activities. That there are dangers that cannot be foreseen, that there are risks and dangers associated with participating in football that coaches cannot control, and that such risks and dangers could result in bodily injury or death to me/my child and/or to others. ·

4. Iunderstand that some of the dangers and inherent risks to melto my child in playing or practicing to play in any sport, and in this case football, include but are not limited to: Death, serious neck and spinal injuries which may result in complete or partialparalysis, brain damage, serious injury related to the eye and/or head, serious injury to virtually all internal organs, serious injury to all bones, joints, ligaments, muscles, tendons, and other partsof the muscular/skeletal system, and serious injury or impairment to other asp(lcts of my/my child's body and generalhealth and well-being. Ifurther understand that there are risks associated with travel and that limy child could incur some or all of these injuries during travelto and from football camp.

5. Iacknowledge that Timpview Football has strongly recommended that limy child seek medical advice concerning my/my child's physical health, conditioning and abilities, prior to engaging in any camp activities. I further acknowledge that I do not/my child does not have any medical conditions that would affect my or/my child's fitness to participate in camp activities.

6. Iagree that if any injury or emergency should occur during camp with respect to myself/my child,the football camp staff is authorized to take whatever steps are _reasonably necessary in their judgment to attend to my/my child's medical needs. Iagree to be responsible for any hospitalexpenses; doctor bills, or other expenses that may be incurred to attend to my/my child's medical needs.

7. Irepresent that Ihave/my child has adequate health insurance to cover the costs of such treatment in the event of any injury that Iincur/my child incurs during participation in the football camp.

8. Iagree to assume all risks and responsibility for any and all claims for damages, including personal injury or death,medicalexpenses, disability, lost wages, loss of earning capacity and property damages which may beincurred by me/my child while engaged in camp activities. '

9. Iagree to indemnify and hold harmless Provo School District, Timpview High School, and Timpview Football and their agents and employees from any loss liability, damage or costs, including court costs and attorney fees, that they may incur due to my/my childs participation in the football camp, whether caused by my/my child's negligence, the negligence of others and/or by the negligence of coaches or trainers (excluding the sole negligence of the District, the School, or Timpview Football).

In signing this release, Iacknowledge and represent that Ihave carefully read the foregoing, that Iunderstand it, and that Isign voluntarily on my own free act and deed. No one has made any oralrepresentation, statements,or inducements in order to get me to sign this document. I have had the opportunity to consult with my own legalcounsel before signing this document. .

• Iam signing this agreement for myself as a participant. Irepresent and acknowledge that if I am eighteen (18) years of age or older !hall understand the terms of this Agreement. I also acknowledge that this Agreement shall bind my heirs and personalrepresentatives.

• ------------------------ ------ --------------------Signature of camp participant Printed name Date

*I am signing this agreement as a legal guardian/parent on behalf of the minor participant above.Iacknowledge!hallam the legalguardian/parent of the participant who is less than 18 years of age and that I understand

the terms of this agreement. This agreement shall be binding upon the participant and the participant'sparents, guardians, heirs and personal representatives . >

( •

Signature of guardian/parent for camp participant Printed name Date

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:J:( E11lCE

ISSUESAND STRATEGIES RELATED .

TO NEGLIGENCE AVOIDANCEasp1ects of an interscholastic athletics program. Generally, negligence allegations cite

lilrJriss,ion of a haZardous act or omission of reasonable act or duty (failure to act) in the manc:e In either case, acts of omission or commission may

both as the actual cause and the proximate cause of an i1/iury. To examine this conceptcompletely, several vocabulary terms and principles are presented hereunder.

Voc ;tbulary, Cautions and Considerations Related to Athletics Practices

·• · ACCIDENT- an unforeseeable,unpredictable and uncontrollable set of circumstances that· causes loss or harm without negligence or carelessness by supervisors. For legal purposesan accident may also be called an "Act of God" (e.g.A set of circumstances beyond

. control, e.g. an accidental collision of two players chasing a loose ball during a contest.) ASSUMPTION OF RISK- A traditional defense against negligence. allegations. A player accepts some risk for obvious hlizards inherent in a sport by participation in athletics

. programs of free will. Players and their parents cannot assume risk for hazards that are not,readily apparent (e.g.the danger in making a head-down football tackle). This defense

is no longer widely accepted as a mitigating circumstance. ...ATIRACTIVE NUISANCE-EQUIPMENT- Facilities that are naturally appealing to young people but when unsupervised are also inherently dangerous (e.g. an unlocked and unsupervised swim pool, weight room or rehabilitation facility). ·

.· BREACH OF DUTY- Failure of a supervisor to carry out a responsibility (omission) or performance of an act that result;; in injury or loss (commission).

·. COMMISSION- Refers to an unsafe act that resulted in injury or loss (e.g. players suffered he!lt stroke when a coach committed an unsqfe act by requiring the football team to run wind sprints in full equipment for 30 minutes in high temperatures and humidity.)COMPARATIVE NEGLIGENCE- A provision oflaw that attributes a percentage of responsibility to the plaintiff and/or the defendant in detennining liability for injury or loss. CONTRIBUTORY NEGLIGENCE - Dangerous or unthili.king behavior on the part ofan injured that contributed to an injurious event despite warnings, prohibitions and appropriate safety instruction..

·· 8. DUTY- A moral obligation or responsibility (e:g. coaches have duty to maintain a hazard-free practice and competitive environment by conducting regular inspections). ·

9. FORESEEABILITY- An identifiable dangerous physical condition or hazardous practice that could lead to harm or loss (e.g.It is foreseeable that athletes could be injured when playing soccer on fields that have deep ruts).

10. LIABILITY -An obligation to compensate for damages or loss.11. OMISSION- Failure to perform a duty or responsibility that resulted in injury or loss.

(Coach leaves athletes alone in a gym. Failure to supervise results in horseplay by athletes that causes a serious injury.)

12. PROXIMATE CAUSE- THE PRIMARY CAUSOF AN INJURY OR LOSS. (Aplayer is struck by a car and injured while crossing the street to practice.) Several factors

-win be considered as the potential pro tl'iate.. These include tbe player's actions, the driver's condition or the condition ofautpn),obile\\'el!therlvisibility, directions given to fu\;pmyGI \lJ tmOOII&h11114 Qftbe plaier, ... . . •.. ....· .·.

13. PRUDENT PROFESSIONALISM- a riSk m@a tilit'Sfraiegy that requires an ongoing.groactiye effort by coaches and athletics administrators to develop and implement plans designed to reduce or transfer the hazards and risks inherent in an athletics Program.Note thatthis obligation' requires a special effort by coaches and athletiCs directors bei:ause of the uniq11e natllre of the knowledge, slrills and hazards iizherent is sport activities.

14. RAGE TO SUE -An llllger level that may develop when a coach's aloof: condescendingor uncaring attitude is coupled with a breach of one or more duties. ·

15. RESPONDEAT SUPERIOR- The negligence of a coach may be imputed to a supervisor. who may also be held accountable for hiring an incompetent coach when it is determined that the coach's fiillure to act or ihe actions of a coach contributed tO an injury or loss. The employer is not responsible for an employee who operates outside the scope ofemployment. Under this theory, athletics directors may also be held liable for failure to train coaches. ·

16. SAFE PLAcE -·several states bave adopted ll'lgislationthat requires higher levels of inspection and scrutiny in creating safe environments for spectator or other large group activities. School activity centers fall into this category. NOTE that individuals and groups who rent school facilities expect them to be safu and in good repair.

17. TRAINED PROFESSIONAL- An individual who bas developed special knowledge,skills and insights about a particular profession that are not shared widely by the generalpopulation. . For coaches and administrators, this definition asswnes ongoing research ofbest practices concerning the instnu:tion of players andpreventingforeseeable injury or ioss thro11gh the exercise of one or. more of the 14 legal dllties that follow.

18. VIOLENT RECKLESSNESS- Anemerging concept that alleges fiillure of a coach or athletics administrator to control the unthinking and violent actions of an athlete or fuilure to supervise athletes and spectators so as to prevent violent confrontations before,during aDd after a contest. . The allegmon may also cite the coach ifthere is any indication of encouragement to players.to pmposely harm, punish or create painfor an opponent.

Elements of NegligenceTo prove that a ooach or athletics adm inistrator was negligent, plaintiff must prove that fourelements were met. 'fh<ise are: ..

1. Duty: The defendant coach or administrator owed a specific duty (obligation of reasonable• i:a¢)).iiJ.det all ciroumstances to an injured player.14 duties or obligations of coaches

and.. . . admijiistra(orswilHie defined in the next section. · · '

· ,.· Cy ,,;,; { ; lt Tw=:t[== fiill!:::= p cau8eof

,''·,· .·· f ·::f!ft::·damilges

lf any of the four elements are oot present or cannot be oroven . the negligence assertion cannot be sustained in court

POTENTIAL DEFENSES AGAINST ASSERTIONS OF NEGLIGENCE

Statutory Immunity A state enacts legislation that prevents an injured party from bringing suit against a public institution including schools or school districts. This is an increasingly rare phenomenon in the United States.·Assumption Of Risk The athlete accepted risk inherent in a sport, was fully warned orapprised of risks that are not immediately apparent and was injured as a result of an unforeseeable event (e.g. a basketball player comes down with a rebound, steps on another player's foot as she lands and rolls her ankle causing an unforeseeable (accidental) injury.)Contributory/Comparative Negligence The athlete is properly instructed in safety techniques and warned of one or more hazardous activities inherent in a sport. Despite the warning, the athlete unpredictably engages in a previously identified hazardous activity that leads to his/her injury or loss.No Supervisory Responsibility The athlete is not under general or direct supervision when·she/he suffers an injury or loss (e.g. after practice has ended, the athlete is strock by a

· •· motorist while crossing a street on his way home).Unforeseeable Event Injury It is well known that injuries occur in sports practices and competitions. To predict that a particular injury would occur at a particular time and thus be foreseeable is not a sustainable defense. See basketball example in Negligence Defense

· Number 2 above.Lack Of Causation The cause of injury or loss was connected to a circumstance other than the performance of a coach or athletics administrator. See motorist example in Negligence Defense Number 4 above.

Fourteen Duties Related to Negligence Litigation lnl::rnlobligations or duties have been identified as absolute requirements for coaches and illietics programs administrators. These standards have the weight of 11l()ral obligation for DIII'Jr:lu!S and athletics administrators and have evolved as a result of various case law!ilu='eedJ'ngsandlega]judgmenJs against individuals and school districts.

of these duties can be further definedandelaborated by more precise examples andapplications or

·.uSidndards of Conduct or Standards of Care" whichwill be elaboratedina subsequent section.

· il. DUTY TO PLAN- This is a comprehensive requirement that transcends all other duties.

. JDherent in this duty is the need to continually conduct focused analyses of potential hazards and todevelop responsive stmtegies that prevent or reduce the potential for injury and loss in the followingareas: coaching competence; medical screening; appropriate activities that Consider age, maturityand environmental conditions;:fucility and equipment evaluation and improvement; injury response;warnings to athletes and their families; insurance of athletes; child advocacy in cases of alcohol andother drug abuse (AODA) or family neglect or abuse. Plans and policies should be rigorously implemented unless dangerous conditions prevent implementation. Plans should become policy docwnents and updated regularly by administrators, coaches and experts in specific areas (e.g. equipment, emergency response, etc.).Negligence can be alleged when an itifury loss results from no planning, inadequate planning or when plans are developed but ignored

lI

2. DUTY TO SUPERVISE- A coachmust be physically present,provide supervision and control of ·

impulsive behavior,compelent instruction.stiucturedpractices1bat are appropriate fur the age and IIIlltlJrit) of players, preventfureseeable uyuriesandrespond tn iJyuryor1raUma in an approved manner. This duty requires supervisoxs to ensme1bat :fucilities arelocked and1bat sbxlents are denied access \IDeo.a ·competent slaff membec cannot be physically presenttn supervise. Supervision responsibilities also pertail.tn athletics ad mini>41aloiS \\bo are expected to be able to supervise coaching staffmembers competently.Inaddition, athletics adminislmtoxs are expectedtn supervise contes1s tn ensme1bat spectatoxs do not Cian unsafe or disruptive environment· A further extension of this duty is the need to supervise the conditiotJsafu usage, maintenance and upkeep of equi}ECilt and fitcilities.

3.. DUTY TO ASSESS ATHLETES READINESS FOR PRAcTICE AND COMPETITIONAthletics administratoxs dreadiness skills and physical condition of athleteS. A progression of skill development and conditionimprovement should be apparent from practice plans. ·Athletes must also be medically screened in ·accordance with state association regulations before participating in practice or cOmpetition. MoJ;eesome children may require specialized medical assessment to ascerlain the existence of congenital}: disordexs or the existence of a physical condition that predisposes the athlete tn injiiry. Inad!Iitio9; l athletes who require the services of a physician may not return to practice or competition withoUI; '#;l

. on gJ:OW from this dUI;y is the difficulty,.assessing the readiness ofhandicapped children.who are referred for practice and competitionAmerican With Disabilities Act or the Education of All Handicapped Children Act of 1975. In

cases, it is imperative that medical and multidiscij>Jiilary team approval·an<l·recommena!tion de olklriibefore a handicapped student becomes a candidate fur practice and competition.

4. DUTY TO MAINTAIN SAFE PLAYING CONDmONS- Coaches are considered trained professionals who possess a higher level of knowledge and skill that permits them to identifY foreseeable causes of injury specific tn a sport and inherent in defective equipment or hazardous environments. Courts have held athletics supervisoxs responsible tn improve unsafe environments, repair, or remove defective equipment or disallow access tn unsafe equipment or envirofitiients. The use of sport-speciftc equipment sqfety checlr:lists can be helpful inenhancing the safety of participants. Inaddition. weather conditions must be considered. Athletes should not be subjected tn intense or prolonged conditioning during periods of extreme heat and hwnidity or when frostbite may be a factor. ·Inaddition, a plan fur monitoring and responding to dangerous weather conditions is necessary. Building codes and laws must be observed and implemented with respect to capacity, ventilation. air filtration and lighting.

5. DUTY TO PROVIDE PROPER EQUIPMENT -Coaches. and athletics administratoxs must ensure athletes are properly equipped with equipment thai is appropriate for the age and maturity of the athletes and that is clean, durable and safe. Fitting should be carried out in acCordance with manufacturer's specifications. This is especially important.for protective

equipment that must carry a Nalional Operating Commission on Safety in Athletics Equipment (NOCSAE) certification and must be checked fur proper fit and wearing. .Athletes must wear · protective equipment any time they are exposed tn the full rigoxs of contact in practice·or competition. Selection of equipment must also consider the age and malurity of the athletes.

DUTY TO INSTRUCT PROPERLY- Athletics practices must be chllr,aqerize4l:ly·· that accounts for a logical sequence of fundamentals that consider the.deyelopmental

·.·>lf:vel of the athlete and that lead to an enhanced progression of player knowlc:dge; skilllritd •:., lplll>ili1y.!F:i,J:IIknlown. Instructor-coaches must be properly prepared to provide appropriate and sequential:· :: = ·and

c· appropriate and safe techniques and must include warning about unsafe techniquesarujlpr<1hibited practices.

DUTY TO MATCH ATHLETES -Athletes should be matched with consideration for maturityskill, age, size and speed. To the degree possible, mismatches should be avoided in all categories.

DUTY TO CONDmON PROPERLY- Practices must account for a progression of··.·•.•c;l.l"diiov;IScl.dar and muscular-skeletal conditioning regimens that prepare athletes sequentially for

:;..· lillOJre challenging practices and competitive activities. Consideration must be given to student readiness and maturational factors. Inaddition, consideration should include weather conditions

::. . iind their impact on student health.

9, . DUTY TO WARN- Coaches are required to warn parents and athletes of unsafe practices that are., .:specific to a sport and the potential for injury or death. Warnings should be issued in writing and both:.· ·athletes and parents should be required to provide written certification of their comprehension. Videotapes

.. ·Of safety instruction and warnings to players and parents are recommended.

10.DUTY TO DISCLOSE AND INFORM:INSURANCE COVERAGE AND OTHER INFORMATION- Athletics administrators and coaches must screen athletes to ensure that

·. fumily and/or school insurance provides a basic level of medical coverage. Athletes should not'be allowed to participate without injury insurance. Deductible and co-payment requirements should be clearly explained to parents and athletes. Certain schools may need to publish this information in several languages. Comprehensions should be required of parents and athletes. Schools need to accurately publish and inform students al>out eligibility criteria such as initial eligibility for the NCAA Clearinghouse.

· 11. DUTY TO PROVIDE EMERGENCY CARE- Coaches are expected to be able to· administer accepted, prioritized, standard first aid procedures in response to a range of traumatic injuries -especially those that are potentially life threatening.

12.DUTY TO DEVELOP AN EMERGENCY RESPONSE PLAN- ATHLETICS administrators and coaches must develop site-specific plans for managing uninjured team members while emergency care is being administered to an injured athlete. Inaddition, plans must be in place to: ensure access to a telephone, a stocked first aid kit, spine board and other emergency response equipment The plan should also account for a timely call to EMS and an expedited access by EMS to the injured athlete by stationing coaches or team members at driveways, parking lots, entry doors and remote hallways.

13. DUTY TO PROVIDE PROPER TRANSPORTATION-In gcineral, bonded, commercial carriers should be used fur out of town trarisportation. Self or family transportation f'Qr local· competition may be allowed if pareDts have adequate insurance coverage for team members other than theidamily members. The age and maturity of athletes should al\vays be considered when allowing athletes to use public transportation to travel to a local contest. A1hletes should be prohibited from driving to an out of town competition, scrimmages or practices.

14. DUTY TO SELECT, TRAIN AND SUPERVISE COACHES- Athletics administrators ·, will be expected to ensure.coaches are capable of providing safe conditions and activities asoutlined inthe preceding list of thirteen duties. ·

DOCUMENTING YOUR RISK MANAGEMENT PROGRAM

I. Spom Participation Agreements Parent permission authorizing participation Sh uld certified inwriting.

· .2. Stadeat & PllrHt IDformation/Emergem:y Contac:t lJJfonnafion and Medieal Treatment Consent Form/Information and Retease should be imme<liately a,vailable to the trainer or coaches.· '·

3. Sport Speeifie Warnings should be issued and comprehension statements executed by parerltsandathletes. .

4. Medical History Questionnaires should be executed at tht: time of the required physical examination. . .

S. Athletics Injury Repom should bC maintained for a period reflective of the State statute of limitations. . . . · · · ·

6. Comprehensive Facilities and Equipment Inspeetion Plans should be documented · Inthis regard, Facilities Inspection Safety Checklists should be issued to all activities supervisors. . . .

7. Doenmenfation of That ManUfacturer Equipment Fitting and WearingReeommendations and NOCSAE I NATA Recommendations were implemented. Some schools videotape the fittiog procedures.

8. Mainteaanee Request & Response Forms should be maintained and facilities closed ormade inacceSsible ifbazardous.

SEXUAL HARASSMENT IN SCHOOLS & ATHLETICS

PROGRAMSfu recent years, there has been an explosion of litigation related to sexual harassment in·and athletics programs. fu its 1998 and 1999 terms, the U.S. Supreme Court made rulings in

harassment cases, three of which dealt with workplace sexual harassment and two ofSJpeC:Ific:ally focused on sexual harassment in schools. The full text of the two school cases,

Monroe County Board of Education and Gebser v. Lago Vista lSD are included in this

Sexual harassment in schools and athletics programs usually occurs in one of three ways. The is workplace sexual harassment- harassment of a school employee or athletics personnel by

school employee or athletics personnel. The second is sexual harassment of a student by aemployee or athletics personnel. The third is sexual harassment of a student by another- "peer" sexual harassment. All three forms of sexual harassment involve similar legal issues

•preventing sexual harassment in schools and athletics starts with a thorough understanding of common legal issues.

'IHE LEGAL DEFINITION OF SEXUAL HARASSMENT

The threshold challenge for any organization attempting to desigu effective policies and ire<lunlSto prevent and correct sexual harassment is to define, as clearly as possible, the behaviors

will fall into the category of prohibited, discriminatory conduct. Title VII, Title IX, and statediscrimination statutes are uniforruly vague in defining sexual harassment Federal and state

have attempted to provide guidance through legislative interpretation, but these judicialtiniltiOJas" of sexual harassment which are derived from court cases tend to be highly situation

and they provide only a fragmented overview of what constitutes illegal gender trirninati"<m and sexUal harassment.

Probably the best starting point for understanding what types of behavior constitute ilplace sexual harassment is the EEOC's legal definition of sexual harassment as stated in its licartimiEri:OCGuidelines For Discrimination On The Basis Of Sa [29 C.F.R § 1604.II(a)]:

Unwelcome sexual advances, requests for sexual favors, and other verbal or physicalconduct of a seX!Jal nature constitute sexual harassment when (1) submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment; (2) submission to or rejection of such conduct by an individual is used as the basis for employment decisions qffecting such individual; or {3} such conduct has the purpose or effect of unreasonably inteiferingwith an individual's work peiformance or creating an intimidating, hostile, or offensive working environment.

Courts have consistently utilized the EEOC's legal definition of sexual harassment as an framework for resolving sexual harassment cases. Specifically, courts have interpreted this

definition as setting forth thiee "hurdles" which a complainant must "clear'' in order to establish that legally prohibited sexual harassment has occurred (in contrast to mere violations of the aforementioned general code of civility, conduct which; although undesirable, does not constitute illegal or actionable discrimination). The three elements of legally prohibited sexual harassment which have been derived by courts from the EEOC definition are unwelcomeness, words or actions of a sexuafnature, and damages. Damages refers to the conditions of harm suffered by a victim of sexual harassment and this element of a sexual harassment claim may be established by the presence of anyone of the three adverse consequences for the victim as they are set forth in the definition. And although the relevance of the distinction between quid pro quo sexual harassment and hostile wom environment sexual harassment has been explicitly diminished as it applies to determining employer liability for supervisor harassment of employees (by the Supreme Court's rulings in two of its 1998 workplace sexual harassment decisions, Burlington Industries and City of Boca Raton), the quid pro quo and hostile wom environment dichotomy is still relevant to the threshold issue whether the conduct in question fits within the definition of sexual harassment Specifically, the quid pro quoand hostile environment analysis is useful in determining whether any of the three conditions of harm in the EEOC definition have occurred (discussed below).

ELEMENT #1:UNWELCOMENESS

The first element which the complainant must establish in a sexual harassment case is thatthe alleged sexual conduct was "unwelcome." Title Vll and most state sexual harassment laws do not prohibit behavior which is consented to by an individual. Therefore, a consensual sexual relationship does not constitute sexual harassment Physical, verbal, or visual conduct of a sexual nature that is consented to or invited by an individual does not constitute sexual harassment. ·

However, and this is a critically important point, the perception of "welcomeneSs" by an alleged harasser may be dramatically different than from the standpoint of an alleged victim.In many EEOC cases and in many federal/state court cases, the alleged harasser asserts the argument that the alleged victim never stated any objection to the behavior in question and that, therefore, the behavior could not have been unwelcome. Yet, in most of the cases, if the alleged harasser was in a superior position of power within 1he organization,both the EEOC and the courts acknowledge the risks inherent in and difficulty for a complainant in communicating unwelcomeness to the harasser: If the conduct in question, under all the circumstances, was sufficiently offensive, unwelcomeness is usually presumed even if the complainant never clearly communicated this to 1he harasser. · ·

The issue of power differential between parties is a key criteria often used to determine whether the behavior in question was welcome. The greater the positional power of one party over the other, the more likely the courts are to conclude that the subordinate had no meaningful choice with regard to challenging the behavior as it was occurring. In such situations, even where thecomplainant never expressly communicated unwelcomeness, it is often presumed Examples of .

- situations where power differential is the key to the welcomeness determination range from repeated, .· non-work-related, social invitations by a supervisor to an employee all the way up to supervisor requests for sexual acts from an employee.

One of the most problematic issues in evaluating unwelcomeness is the impact of a voluntary .·relationship between two parties in the past on a claim that unw lcome viorpresent Both the EEOC and the courts have concluded that ten . by one of the two parties involved, future ccnduct by e Qt!l<:r imjt fa!!intothe category of· · · ·

··$1wellcoJmeJ ess.longer welcome. Therefu..--e, continuing requests for activities ranging from anything as simple as

oo.:;; da teIX relationship between the parties, may now be unwelcome and give rise to a sexualIJarass:meJat complaint.

A simple, preventative measure whim can be encouraged by an employer as part of sexual ilan!SSineilt education and training for employees is to encourage employees to clearly communicate1!11vvel<:on1eness to the objectionable conduct of other parties. Common sense and context can let :rmine

vAt·h l communication of unwelcomeness may suffice. In other situations, a written format forlle.cornm.uni.cation of unwelcomeness may be preferable both to emphasize the seriousness of the:::::to the other party and to "paper the trail" that unwelcomeness was, in fact,

Equally important to include in sexual harassment education and training for company:ci:si th =at

Ill of unwelcomeness against !he individual who communicated that message.tetalia1iion, by itself has been determined to be a form of sexual harassment both by EEOC policy

an extensive series of federal and state court cases in which, although the damages resulting the original sexually harassing behavior were limited, the damages resulting from subsequent

lllJiaticm against a complainant were substantial

. ELEMENT #2: WORDS/ACTIONS OF A SEXUAL NATURE

The second element which the complainant must establish in a sexual harassment case is that!UJtdm;t in question included words or actions of a sexual nature. Disparate treatment

&ased·on clearly falls into this category. When a female employee is being treated differently than a situated male employee, discrimination is occurring even if the

offending behavior is notsexual in nature. Activities such as basing promotions on sexual stereotypes, excluding

but not men wi$, children from employment, and requiring only female employees to wear clothing on the job are exan1ples of disparate treatment which have been held by the courts to

- category. Employers must exercise extreme caution in developing evaluative criteria for

.-.-r.,,a,.,u decision making (hiring, promotion, assignment, etc.) and must avoid eitheror implicitly making distinctions based solely on gender.

A complainant may also satisfY this second element by demonstrating that the offending involved explicitly sexual advances, requests for sexual favors, or other physical, verbal, conduct of a sexual nature. The fOllowing is a non-exhaustive list of some of the types of which courts have determined as constituting "words or actions of a sexual nature":

Sexual assault or sexual battery as defined by the applicable federal, state, and local criminal statutes.Stalking behavior or criminal harassment behavior as defined by the applicable federal, state, and local criminal statutes.

• Explicit demands for sex in exchange for favorable treatment with regard to any aspect of the employment relationship, including hiring, evaluation, promotion, retention, salary, or benefits.

• Explicit demands for sex accompanied by the threat of unfavorable treatment with regard to any aspect of the employment relationship, including hiring, evaluation, promotion. retention, salary, or benefits.

• Unwelcome physical contact or touching of a sexual nature, including brushing against the body, pinching, blocking of normal physical movement, or unreasonably close physical proximity of a sexual nature.

• Unwelcome and persistent verbal conduct of a sexual nature, including sexual jokes, sexual epithets, sexual propositions, sexual gestures, sexual slurs or insults, or verbal abuse of a sexual nature.

• Unwelcome and persistent verbal comments of a sexual nature about an individual's appearance, sexuality, sexual attitudes, sexual prowess, or sexual deficiencies.

• Unwelcome and persistent visual harassment of a sexual nature, including continual leering or stating, and repeated attempts to take photographs.

• Unwelcome and persistent inquiries into one's sexual experiences, sexual history, and sexual activities.

• Unwelcome and ongoing gossip regarding someone's sex life, sexual orientation, or sexual interests.

• Display in the workplace of sexual pictures, posters, photographs, cartoons, or drawings.• Unwelcome or unwanted conduct or comments consistently targeted at or involving only

one gender, even ifthe conduct is not overtly sexual. ,

ELEMENT #3: DAMAGES [HARM TO THE VICTIM]

The EEOC definition of sexual harassment establishes a three-prong test for evaluating whether the alleged victim of sexual harassment has suffered harm. A complainant must prove only one of the three alternative conditions in order to satisfY the damages component of a sexual harassment case. Again, any one of the three following conditions of harm will get the complainant over this third evidentiary "hurdle." Unwelcome words or conduct of a sexual nature will constitute sexual harassment when: ·

(J) submission to such conduct is made either explicitly or implicitly a term or condition of an individual's employment;

OF

(2) submission to or rejection of such conduct by an individual is used as the basis for employment decisions qffecting such individual;

OF

(3) such conduct has the purpose or effect of unreasonably inteifering with an individual's ·work performance or creating an intimidating, hostile, or o.ffonsive working environment.

The first two above-defined conditions of harm involve the situation where the complainant an adverse, tangible workplace detriment as a result of the offending behavior. The first

submission to the behavior being made a term or condition of the individual'siljlnertt, covers those situations where someone with authority is offering a job to an applicant,

of employment to an employee, in exchange for sexual favors. The second condition,to or rejection of the conduct being used as the basis for employment decisions, covers

sinJations where someone with anthority uses any aspect ofldoVJne11t relationship (promotion, demotion, assignment of work or projects, transfer, salary,

as leverage to request sexual favors. Under either of these closely related scenarios,are being forced to comply, because of their sex, with conditions that other company

do not face.

Quid Pro Quo Sexual Harassment

of these first two conditions of harm constitute the type of sexual harassment typically as quid pro quo. Although this terminology was not expressly incorporated in the Title

jslatio11, the EEOC created this "label" to refer to those situations where someone with using employment benefits or detriments as leverage in an attempt to coerce sexualthe victinl. After the phrase quid pro quo began to be used by the EEOC Inthe mid

:;;.··-" soon adopted by courts to describe sexual harassment scenarios where the threeof the EEOC definition were established by showing (1) unwelcomeness; (2) words or acts nature; and (3) dantages evidenced by either of the first two conditions of harm (requests favors as the basis of an employment detriment suffered by the victinl).

Until the enunciation of new legal standards in the 1998 Supreme Court decisions in dir.rgk•n Industries and City OfBoca Raton, the quid pro quo determination was a critically porltant one, because it invoked a stricter standard of liability for an employer based on the quid

harassment by a supervisor of an employee.If the elements of a supervisor-employee quidclaim were proven, then the employer was subject to "strict liability" for the misconduct of

eSIIJ)elrvi1>0r. Strict liability, in effect, means that the employer is automatically liable and that the onlr•v"'r has no defenses available to prevent liability. Therefore, in quid pro quo cases, regardless

quality of a company's sexual harassment policies and procedures, renegade misconduct by asupervisor could result in automatic and indefensible liability for the employer.

The rule of law set forth by the Supreme Court in the Burlington Industries and City Of:aHawn cases, however, established a new legal standard for employer liability which operates

13pemlently of quid pro quo analysis. The issue no longer deals with the issue of whether the sex-for-employment consequences bargain was actually proposed by the supervisor and

the illegal offer was the basis of the detriment suffered by the employee (an analysis that is contract-law-like; who offered what and based on what consideration).

The new legal standard simply states that if an employee has suffered an adverse, tangible consequence then the employer is strictly liable and no defenses are available. However, if the

IIJ>l oyclesuccessfully assert the affirmative defense that the employer exercised reasonable care to

and correct promptly any sexually harassing behavior and the employee unreasonably failed advantage of the preventative or corrective opportunities provided by the employer or to

harm otherwise. There is no employer liability issue regarding whether the supervisor offered

Timpview High SchoolEvent Facility Request Form

All items must be filled out on the form in order for the request to be reviewed. Once approval has been given, the event will be placed on the school calendar and notification will be sent to the person requesting the facility. Only completed requests will be considered for approval. Please allow sufficient time for request to be reviewed. Understand that we do have limited space and we usea scheduling matrix to determine priority for gym use. The rank order is:

1. In-season, state-sanctioned sports and activities2. In-season, school affiliated sports and activities3. City Rec (Winter only)4. Out-of-season, school affiliated sports and activities5. Non-school sports, activities & clubs, and includes all rentals

The administration, facilities coordinator, and athletic director reserve the right to make all final decisions regarding event approval and facility usage.

Even ·---------------------------------------------------------

Contact Person/Supervisor & Phone Number-· _

Dates/Times & Facility (location desired)- _

Indicate the tier level of event (See order listed above 1-5)-

_ The calendar was checked prior to my request (Yes or No)-·

_ Reason for facility request and the goal of the event-

Any additional paperwork is completed if required regarding rental agreements and insurance and liability etc. and is attached. (Yes/No) _

Request- ApprovedNot Approved (Reason) _

Request sent to calendar (date & by whom)