ANACORTES MIDDLE SCHOOL

Athletics

Welcome to the Anacortes Middle School Athletic Department. We are looking forward to your student athlete

joining our program. Here is the information to help you prepare for the upcoming sports seasons:

SPORTS OFFERED

Here is a list of the things to do so your student can participate in a sport:

1. Fill out and return the attached Athletic Registration Signature Form to the middle school. This is good

for the entire year.

2. Fill out and return the attached Emergency Authorization Form to the middle school. This is good for

the entire year.

3. Complete a physical and return the attached form to the middle school. These are good for two years.

If your student is a seventh grader, they will most likely need a physical done this school year. Golf is

the only activity that a physical is not required.

4. Read the Anacortes Middle School-Activities/Athletic Code. Sign and return the Activities/Athletic

Code Form to the middle school. This is good for the entire year.

5. Pay the $35.00 sports fee for each sport participation, up to a $200.00 maximum per family. The

sports fee is due before each game/match/meet. Financial assistance is available. Please contact Mark

Perkins at 360-503-1245, or a counselor at 360-503-1240.

Student athletes are required to pass a grade check, which will occur at various times throughout the season(s).

For up-to-date schedules go to http://www.nwcathletics.com/

Please do not hesitate to call the Athletic/Attendance Office at 360-503-1248 with any questions.

Mark Perkins,

Anacortes Middle School Athletic Director

Fall Season (Sept-Oct) Co-ed Cross Country

Girls Soccer

Golf

Winter Season 1 (Nov-Dec)

Girls Volleyball (After Thanksgiving)

Boys' Basketball

Winter Season 2 (Feb-March) Wrestling

Girls Basketball

Spring Season (After April break)

Boys Soccer

Co-ed Track

Golf

Fitness Cub

Anacortes Middle School GRADE ______

2019-20 School Year Athletic Registration Signature Form

THIS FORM MUST BE COMPLETED IN FULL TO PARTICIPATE IN SPQRTS

Student Name: __________________________________________ Age: ______ Birth date: ___/ ___/ ___ Sex: ______

Parent/Guardian Name: ___________________________________________ Home/cell #: _______________________

Address: ____________________________________________City: ___________________Zip: ___________________

Do you reside in the Anacortes School District? Yes____ No____

Turning Out for: (Fall) _____________________________ (Winter 1) ___________________________________

(Winter 2) ___________________________ (Spring) ___________________________________

Students participating in interscholastic sports must be covered by an accident insurance plan. Either the family can provide

this or you can purchase the school insurance plan offered through the school district. Please choose one from below:

_____I have personal insurance coverage through ____________________________________ (Company name) the

equivalent or better than the Washington State Industrial Insurance Fee Schedule for doctors' services or

hospitalization and I will continue to keep it in force throughout the sports seasons.

_____I have purchased school insurance on ____________ (date). (Confirmed _________)

Physical: I have attached a copy of a physical that is dated within the last 2 years. PARENT INITIAL HERE: _________

MRSA Form: We have read the information about communicable diseases. We understand that it is our responsibility to

make sure our student has their own water bottle, showers after practices and competitions using their own personal items

and has clean practice and competition clothing. We will notify the coach of any potential skin infections or if our

student is diagnosed with mononucleosis or any other communicable disease.

PLEASE INITIAL HERE: parent ________ athlete ________

Concussion Information Sheet: We have read and understand the information provided, including the symptoms and

signs of a concussion. We are aware that up-to-date information can be found at www.cdc.gov, Concussion in Youth Sports.

PLEASE INITIAL HERE: parent ________ athlete ________

Risk Management Release Form: Each sport has its own sport specific safety guidelines. We agree that neither the school

district, nor the staff of the school district, nor the student organization of the school district shall in any way be held liable

for an accident or injury in anyway received on account of or while engaged in any athletic activity sponsored by the

district. We further agree that neither the district nor any of their staff or student organizations shall be responsible for the

payment of any bills rendered for medical services as a result of such accidents or injury. We also acknowledge that it is

our responsibility to provide for any medical, disability or other insurance to mitigate any costs that may be unfortunately

incurred as a result of participation in any sport activity. I certify that I have read this Safety Guidelines for my specific

sport, understand its content and agree to its terms.

PLEASE INITIAL HERE: parent _________ athlete

All middle school athletes must pay a sport fee during the first week of practice. PLEASE INITIAL HERE: parent ________ athlete _______

We (parent/athlete) have read and completed the above information, including the insurance coverage information, the

Athletic/Activities Code of Conduct, MRSA form, Concussion Information Sheet, Risk Management Release Form. I

(parent/guardian) will accept full responsibility for the cost of treatment for any injury that my / our child may suffer

while taking part in the program.

_____________________________ _______ _____________________________ _______ Parent / Guardian Signature Date Athlete Signature Date

PLEASE PRINT

USING A DRK

BLUE OR BLACK

PEN

ANACORTES SCHOOL DISTRICT Grade_______________

EMERGENCY AUTHORIZATION FORM

To be filled out by parent/guardian. Please answer each question, and sign/date at the

bottom.

STUDENT NAME_______________________________________________________BIRTHDATE_____/____/____AGE_____

PARENT/GUARDIAN #1 ____________________________________________________________________________________

NAME/PHONE/CELL/PAGER#

PARENT/GUARDIAN #2 ____________________________________________________________________________________

NAME/PHONE/CELL/PAGER#

E-MAIL ADDRESSES: _______________________________________________________________________________________

IN AN EMERGENCY, IF PARENTS CANNOT BE CONTACTED, NOTIFY THE FOLLOWING, WHO HAS OUR

PERMISSION TO GIVE MEDICAL RELEASE:

NAME__________________________________________________________PHONE#__________________________________

FAMILY DR.____________________________________________________PHONE #__________________________________

PREFERRED

HOSPITAL_________________________________________________________________________________________________

KNOWN ALLERGIES OR CHRONIC

PROBLEMS________________________________________________________________________________________________

___________________________________________________________________________________________________________

HAS YOUR CHILD HAD A HEAD INJURY SINCE THEY LAST PARTICIPATED IN A SCHOOL SPORT?

YES _____ NO_____

The team physician, trainer and coach may apply first aid treatment until the family doctor can be

contacted. YES _____ NO_____

I, ____________________________________________________________, the parent/guardian of the

above named student, hereby give permission for the coaches, athletic trainer, and other appropriate

school district personnel to use their own judgment in securing medical aid, ambulance service, and the

release of any medical records they deem necessary for the treatment of my student. YES _____ NO_____

Please list below those persons with whom we may not share medical information:

____________________________________________________________________________________________________________

____________________________________________________________________________________________________________

PARENT/GUARDIAN SIGNATURE_____________________________________________________ DATE_____/_____/_____

PLEASE PRINT

USING A DRK

BLUE OR BLACK

PEN

PREPARTICIPATION HISTORY AND PHYSICAL EXAMINATION This form is not required as long as the conditions of 18.13.0 are met.

Name: _____________________________________ Birth Date: ______________ Exam Date: ______________

Address: ______________________________________ City: __________________________ Zip: ___________

Phone: _______________________________________ Sport: ________________________________________

HISTORY

****ATHLETE SHOULD NOT WIRTE BELOW THIS LINE****

EXAMINER’S COMMENTS ON ALL “YES” ANSWERS (refer to question number):

Yes No 1. Have you had any illness/injury recently, or do you have an illness/injury now?

2. Have you had a medical problem, illness or injury since your last exam?

3. Do you have any chronic or recurrent illness?

4. Have you ever had any illness lasting more than a week?

5. Have you ever been hospitalized overnight?

6. Have you had any surgery other than tonsillectomy?

7. Have you ever had any injuries requiring treatment by a physician?

8. Do you have any organ missing other than tonsils (appendix, eye, kidney, testicle, etc.)?

9. Are you presently taking ANY medications (including birth control pill, vitamin, aspirin, etc.)?

10. Do you have ANY allergies (medicines, bees, foods, or other factors)?

11. Have you ever had chest pain, dizziness, fainting, passing out during or after exercise?

12. Do you tire more easily or quickly than your friends during exercise?

13. Have you ever had any problem with your blood pressure or your heart?

14. Have any close relatives had heart problems, heart attack or sudden death before they were age 50?

15. Do you have any skin problems (acne, itching, rashes, etc.)?

16. Have you ever had fainting, convulsions, seizures or severe dizziness?

17. Do you have frequent severe headaches?

18. Have you ever had a "stinger" or "burner" or "pinched nerve"?

19. Have you ever been "knocked out" or "passed out?

20. Have you ever had a neck or head injury?

21. Have you ever had heat exhaustion, heat stroke, heat cramps or similar heat-related problems?

22. Have you had asthma, or trouble breathing, or cough during or after exercise?

23. Do you wear eyeglasses, contact lenses or protective eyewear?

24. Have you had any problem with your eyes or vision?

25. Do you wear any dental appliance such as braces, bridge, plate, or retainer?

26. Have you ever had a knee injury?

27. Have you ever had an ankle injury?

28. Have you ever injured any other joint (shoulder, wrist, fingers, etc.)?

29. Have you ever had a broken bone (fracture)?

30. Have you ever had a cast, splint, or had to use crutches?

31. Must you use special equipment for competition (pads, braces, neck roll, etc.)?

32. Has it been more than 5 years since your last tetanus booster shot?

33. Are you worried about your weight?

34. FEMALES: Have you any menstrual problems?

35. Have you any medical concerns about participating in your sport?

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

___________________________________________________________________________________________________

_____________________________________________________________________________________________

Urinalysis:

Body Fat %

HCT:

EST V02 Max:

Audiometry:

PHYSICAL EXAMINATION

Optional

Age: _____________________ Pulse: ________________________

Height: ___________________ Blood Pressure: ________________

Weight: ___________________ Visual Acuity: Left 20/___________

Right 20/_________

Normal

1. Head

2. Eyes (pupils), ENT

3. Teeth

4. Chest

5. Lungs

6. Heart

7. Abdomen

8. Genitalia

9. Neurologic

10. Skin

11. Physical Maturity

12. Spine, Back

13. Shoulders, Upper extremities

14. Lower extremities

Full participation

Limited participation (describe imitation, restrictions

_________________________________________________________________________________________

_________________________________________________________________________________________

Participation contraindicated (list reasons):

_________________________________________________________________________________________

_________________________________________________________________________________________

Recommendations (equipment, taping, rehabilitation, etc,):

_________________________________________________________________________________________

_________________________________________________________________________________________

EXAMINER’S SIGNATURE: ____________________________________________________________________________

PRINT EXAMINER’S NAME: ___________________________________________________________________________

DATE: __________________________ EXAMINER’S PHONE: ___________________________________

Abnormal

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

_________________________________________________ _________________________________________________

___________________________________________________ _________________________________________________

__________________________________________________ _________________________________________________

Please return this sheet to Athletic Office

ATHLETIC/ACTIVITY CODE

I/We realize it is considered a privilege to participate in the activity/athletic

programs of Anacortes School District. I hereby agree to obey the rules and

regulations set up by the Anacortes School District and the W.I.A.A.

We, the student and parents, acknowledge we have received a copy of the Anacortes

Middle School Activity/Athletic Code and agree to abide by the rules and

regulations of the Anacortes Middle School Activity/Athletic Code.

I/We authorize local law enforcement to release arrest information relating to

delinquent behavior, drug, alcohol consumption for my/our student athlete, upon

request to the Anacortes School District.

_________________________________________

Participant Printed Name

_________________________________________ _________________

Participant Signature Date

_________________________________________ _________________

Parent/Guardian Signature Date

PARENT/

GUARDIANS -

KEEP ALL

PAPERS

BEYOND THIS

POINT.

• Appears dazed

• Vacant facial expression

• Confused about assignment

• Forgets plays

• Is unsure of game, score, or opponent

• Moves clumsily or displays lack of coordination

• Answers questions slowly

• Slurred speech

• Shows behavior or personality changes

• Can’t recall events prior to hit

• Can’t recall events after hit

• Seizures or convulsions

• Any changes in typical behavior or personality

• Loses consciousness

ANACORTES SCHOOL DISTRICT

Concussion Information Sheet

A concussion is a brain injury and all brain injuries are serious. They are caused by a bump, blow, or jolt to the head,

or by a blow to another part of the body with the force transmitted to the head. They can range from mild to severe

and can disrupt the way the brain normally works. Even though most concussions are mild, all concussions are

potentially serious and may result in complications including prolonged brain damage and death if not

recognized and managed properly. In other words, even a “ding” or a bump on the head can be serious. You can’t

see a concussion and most sports concussions occur without loss of consciousness. Signs and symptoms of

concussion may show up right after the injury or can take hours or days to fully appear. If your child reports any

symptoms of concussion, or if you notice the symptoms or signs of concussion yourself, seek medical attention right

away.

S

• Headaches

• “Pressure in head”

• Nausea or vomiting

• Neck pain

• Balance problems or dizziness

• Blurred, double, or fuzzy vision

• Sensitivity to light or noise

• Feeling sluggish or slowed down

• Feeling foggy or groggy

• Drowsiness

• Change in sleep patterns

• Amnesia

• “Don’t feel right”

• Fatigue or low energy

• Sadness

• Nervousness or anxiety

• Irritability

• More emotional

• Confusion

• Concentration or memory problems

• (forgetting game plays)

• Repeating the same question or comment

•

•

•

•

What can happen if my child keeps on playing with a concussion or returns too soon?

Adapted from the CDC and the 3rd International Conference on Concussion in Sport Document created 6/15/2009

Up-dated 10/18/2012

Page 1 of 2

Symptoms may include one or more of the following:

Signs observed by teammates, parents and coaches include:

ANACORTES SCHOOL DISTRICT

Concussion Information Sheet

Athletes with the signs and symptoms of concussion should be removed from play immediately. Continuing to play

with the signs and symptoms of a concussion leaves the young athlete especially vulnerable to greater injury. There is an increased risk of significant damage from a concussion for a period of time after that concussion occurs,

particularly if the athlete suffers another concussion before completely recovering from the first one. This can lead to

prolonged recovery, or even to severe brain swelling (second impact syndrome) with devastating and even fatal

consequences. It is well known that adolescent or teenage athletes will often under report symptoms of injuries. And

concussions are no different. As a result, education of administrators, coaches, parents and students is the key for

student-athlete’s safety.

If you think your child has suffered a concussion

Any athlete even suspected of suffering a concussion should be removed from the game or practice

immediately. No athlete may return to activity after an apparent head injury or concussion, regardless of how

mild it seems or how quickly symptoms clear, without medical clearance. Close observation of the athlete

should continue for several hours. The new “Zackery Lystedt Law” in Washington now requires the consistent

and uniform implementation of long and well-established return to play concussion guidelines that have been

recommended for several years:

“A youth athlete who is suspected of sustaining a concussion or head injury in a practice or game shall be

removed from competition at that time”

and

“…may not return to play until the athlete is evaluated by a licensed heath care provider trained in the

evaluation and management of concussion and received written clearance to return to play from that health care

provider”.

You should also inform your child’s coach if you think that your child may have a concussion. Remember it’s

better to miss one game than miss the whole season. And when in doubt, the athlete sits out.

For current and up-to-date information on concussions you can go to:

http://www.cdc.gov/ConcussionInYouthSports/

Adapted from the CDC and the 3rd International Conference on Concussion in Sport

Document created 6/15/2009 Updated 10/18/2012

Page 2 of 2

Dear Parents of Athletes,

In recent years, there has been an increase in the number of communicable diseases being spread from one athlete to another. We

would like to take this opportunity to inform you about three communicable diseases associated with sports and ways you can help us

prevent the spread of these diseases.

Skin Infection – Staph Infections (MRSA)

In some sports, athletes have skin-to-skin contact or equipment that may chafe the skin. Both of these conditions increase the chance

of a skin infection. There are a growing number of athletes that are being diagnosed with staph infections. Staph is a type of bacteria

that is commonly found on the skin and in the noses of healthy people. Approximately 25-30% of the population carries staph in their

noses. Staph bacteria are one of the most common causes of skin infections in the United States. Although it is usually harmless at

these sites, it may occasionally get into the body through breaks in the skin such as abrasions and cuts, causing an infection. These

infections may be mild (pimples, boils) or serious (causing infection of the bloodstream, bones or joints). Over the past 50 years,

treatments of these infections have become more difficult because staph bacteria have become resistant to various antibiotics,

including the commonly used penicillin-related antibiotics. One of these resistant bacteria is called Methicillin-Resistant

Staphylococcus Aureus (MRSA).

How is Staph transmitted?

• Abrasions and skin trauma allow the bacteria to enter through a break in the skin.

• Protective clothing retains body heat and may chafe the skin resulting in abrasions/lacerations.

• Person to person contact

• The use of shared equipment items that are not cleaned or laundered between users.

What to do you do if you notice your student has a skin infection:

• Notify your coach immediately.

When do I take my student to a health care provider?

If you or your coach notice that your student has a possible infection (pain, redness, swelling and increased temperature at the site, and

oozing pus or blood). Here are a few common skin infections caused by the staph bacteria:

• Boils-tender, red bumps that swell and get white heads like large pimples. Boils form on oily or moist skin such as the neck,

armpits, groin and buttocks. They may break open and ooze pus or blood.

• Impetigo- Blisters with fluid in them, which may pop and get a yellow crust. Children often get it on the face. It can spread

by scratching.

• Infected hair roots (follicles) small bumps under the skin at the base of the hair. They may itch.

What your health care provider may do:

• Your health care provider might may drain the sore and take a culture of the skin lesion

• If antibiotics are prescribed, your student should take the full course ad call your health care provider if the infection does not

get better.

What will happen if my student has a skin lesion?

• Your student will be restricted from participating if they have open draining would/sores until the wounds/sores have healed

and your health care provider has cleared your student.

Mononucleosis

Mononucleosis is transmitted through close person-to-person contact. (Kissing or using personal items which may be contaminated

with saliva such as water bottles). The Epstein-Barr virus causes infectious Mononucleosis or “Mono”. This is an acute and usually

benign infectious disease. Most students recover uneventfully in 2-4 weeks. Symptoms may wax and wane.

What are the common signs and symptoms of Mono?

• Fever

• Headache

• Enlarged liver or spleen

• Fatigue (may persist for several weeks and

occasionally for months)

• Sore throat

• Swollen glands, especially in the neck

• Jaundice- “yellow” skin and whites of the eyes

How is Mono transmitted?

• Sharing drinks

• Kissing

How long does my student have to be out of school/sports?

• Students may return to school when they no longer have a fever for 24 hours.

• The student should avoid PE and contact sports for six to eight weeks after the onset of the illness,

since the spleen and liver can be enlarged and are more susceptible to possible injury and/or rupture.

• The student should avoid heavy lifting or strenuous exercise until the spleen/liver enlargement has

disappeared.

What precautions should be taken when your student has Mono?

• Students should not share food or drinks.

• Students should practice good hand washing.

• If the student receives an injury to the area below the rib cage, call 911.

Bacterial Meningitis

Bacterial Meningitis is transmitted from person to person through respiratory droplets. One team member

who has the bacteria could potentially transmit it to others through close personal contact.

What are the common signs or symptoms of bacterial meningitis?

• High fever and chills

• Headaches

• Sometimes a rash

• Stiff neck

• Vomiting

• Seizures

Prevention

How to prevent Staph Infections:

• Good hygiene – athletes should shower with soap and water after all practices and competitions.

• Avoid contact with wounds or material contaminated with drainage rom skin lesions.

• Do not share towels, clothing, equipment and or personal items (Razors, lotions, balms, deodorant,

bars of soap).

• Towels, uniforms and practice clothes must be washed daily in hot water and dried on the hot setting

in the dryer. Do not line-dry the clothing.

• Do not share headgear, kneepads or any other equipment. Equipment should be cleared daily using a

1:10 bleach solution to disinfect the article.

How to prevent Mono and Bacterial Meningitis:

• Athletes should use his/her own water bottle.

• Athlete should use her/his own cup if a water cooler is used.

• Athletes should not put their hands into the water source ad scoop out water.

• Athletes should not share food.

• Good hand washing is the single most effective way to reduce the spread of disease.

Athletic Director

Anacortes School District 103

2200 M Avenue Anacortes, Washington 98221

Phone 360-293-1200 / Fax 360-293-1222

http://www.asd103.org

Dear Parent/Guardian:

This letter informs you that risks are involved when your child participates in a school sponsored extra-

curricular activity. Many of the activities have inherent risks, whether it is traveling to and from the activity,

actual participation in the activity, or practices leading up to the event. While the District will pursue

procedures for reducing risks, it is possible that an accident could happen involving serious bodily injury or

even death. The attached Informed Consent Form includes a more detailed statement of the risks involved.

To protect all prospective student athletes, the State of Washington has mandated that all participants be

enrolled in a current insurance program and/or participate in the District’s accidental medical insurance

program. It is your responsibility, not the Anacortes School District’s, to pay for any medical payments

required as a result of an injury that occurs in an extra-curricular activity.

Please sign and return the enclosed form to your son/daughter’s school office prior to participating in a school

activity. We are also requesting that you advise us of what arrangements, if any, you have made for the

insurance protection of your child.

Thank you for your participation and support of our District’s extra-curricular activity program!

Sincerely,

Dr. Mark Wenzel, Superintendent

Mark Perkins, AMS Athletic Director,

Erik Titus, AHS Athletic Director

Enc.

Ref: ASD School Board Policy 2151

RCW 21A.400.350

Inherent Risks in Athletics BASKETBALL * Recognize the possible danger from such actions as "undercutting" a player, hanging on the basket, throwing a "wild" pass.

CROSS COUNTRY * Run only on the course prescribed by the coach. * Run in pairs in unfamiliar territory or in areas where there are few people. * Watch for objects thrown from passing cars. * Approach dogs with caution. * Be familiar with basic first aid treatment for heat exhaustion, heat stroke, sprained ankle, or other runner related injuries. * Face the oncoming traffic when running on the roads. Be cautious at intersections and be acutely aware of erratic drivers and the location of vehicles at all times.

GOLF * Before swinging the club, make certain that the area around you is clear of others. Be careful after hitting not to throw the club as you could injure someone. * Be aware of the danger of standing in front of or on the side of a person who is attempting to hit the ball, as one may be injured by the ball or by the rebounding of the ball from trees, signs, markers, etc. * Be aware at all times of other players' positions on the course when you are hitting or when they are hitting. You are vulnerable at all times. Do not hit the ball until proper distance is available between golfing groups. If you observe a ball off course, make any nearby group aware of its existence by shouting or other appropriate means. * Keep hands and grips dry to minimize the danger of losing grip on clubs.

SOCCER * Use equipment that complies with FIFA and/or WIAA rules, e.g., footwear, shin guards. * Comply with soccer rules with special attention given to avoiding such violations as: kicking or attempting to kick an opponent, tripping an opponent, jumping at an opponent, charging an opponent from behind, charging violently at an opponent, striking or attempting to strike an opponent, holding an opponent, pushing an opponent, and playing in a manner considered by the referee to be dangerous such as kicking at a shoulder high ball when an opponent is trying to head it.

TRACK & FIELD * Recognize the safety rules for restricted areas, e.g., javelin, discus, shot put, pole vault. These areas must be supervised. * Stay on the designated running courses. * Check equipment, apparatus, field and pits thoroughly before each use, e.g., debris in jumping pits, placement of standards.

VOLLEYBALL * Be aware of court surroundings, i.e., obstacles, projections, bleachers, standards, etc.

WRESTLING * Recognize illegal holds as defined by the rule book. * Wear approved proper-fitting apparel when wrestling with an opponent, either in practice or in a match. * Wrestle a safe distance from all walls and other obstructions. All wrestling will be done on the mats provided for wrestling.

The above information has been explained to me and I understand the list of rules and procedures. I also understand the necessity of using the proper techniques while participating in all of the sports programs. Because of the dangers of the above sports, I recognize the importance of following coaches’ instructions regarding techniques, training and other team rules, etc., and to agree to obey such instruction. I am aware that the above sports are HIGH-RISK SPORTS and that practicing or competing in the above sports will be a dangerous and unpredictable activity involving MANY RISKS OF INJURY. I understand that the dangers and risks of practicing and competing in the above sports include, but are not limited to, death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, blindness, serious injury to virtually all internal organs, serious injury to virtually all bones, joints, ligaments, muscles, tendons and other aspects of my body, general health and well-being. I understand that the dangers and risks of practicing or competing in the above sports may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities and generally to enjoy life. We agree that neither the school district, nor the staff of the school district, nor the student organization of the school district shall in any way be held liable for any accident or injury in any way received on account of or while engaged in any athletic activity sponsored by the district. We further agree that neither the district nor any of their staff or student organizations shall be responsible for the payment of any bills rendered for medical services as a result of such accidents or injuries. We also acknowledge that it is our responsibility to provide for any medical, disability or other insurance to mitigate any costs that may be unfortunately incurred as a result of participation in this activity.

Anacortes Middle School-Activities/Athletic Code

THIS IS A 365 DAY POLICY – 24 HOURS A DAY ACCUMULATIVE OVER 6 YEARS (24/7/365) Revised: August 2016

1. PARTICIPANTS COVERED BY THIS CODE

The following are considered athletics/activities and include, but are not limited to: all interscholastic

athletics governed by WIAA, student body officers, cheerleaders, performing drama groups, performing

music groups, debate and other activity organizations recognized by the ASB and represent the school in

public settings.

2. PHILOSOPHY

Anacortes Middle School is proud of the athletic/activity programs and encourages all students to be

involved. Coaches, advisors and administrators, who are responsible for the conduct of students during

activities, feel the opportunity of participating in athletic/activity programs is one of the most valuable

educational experiences in a student's life. The academic, moral, physical and healthful aspects of a well-

run athletic/activity program are of unquestionable value to the participants. It is a privilege to

participate. Those who participate in the Anacortes School District programs require the highest possible

standard of conduct and training.

3. PERIOD OF COVERAGE

Upon initial participation of middle school athletics and activities, the code will apply through graduation

whether the student participates in one sport/activity or many. There will be no time during the year

designated as off-season. This includes middle school students playing high school athletics in the

summer time.

4. THIS CODE IS CUMULATIVE

The code is based upon the concept of progressive discipline throughout a student's middle and high

school experiences. This means disciplinary action will be more severe for the second and third offenses.

It also means incidents resulting in disciplinary action will accumulate over a student's middle and high

school careers.

5. ACADEMIC STANDARDS

To run for a class or ASB office and to remain academically eligible to participate in a school sanctioned

extracurricular athletic and/or activity program, a participant must meet the following minimum criteria in

the semester prior to when the activity commences. The final spring grades (Semester 2) will

determine initial fall and winter academic eligibility. The final winter grades (Semester 1) will

determine initial spring eligibility.

● The student must be passing all classes and have at least a 2.0 GPA. However, one F is

allowed.

o (2) or more F’s – Academically ineligible for five weeks.

o Ineligibility refers to competition. Participants are still expected to attend and participate

in practices. Attendance at competitions is up to coach’s discretion.

o Athletes may not drop or withdraw from a class in order to remain eligible.

o A three-week grade check will be done for all participants to determine their eligibility

status for the remainder of the season. The three weeks is determined in the fall season

from the first day of school, and for the winter and spring seasons from the first day of

practice.

o WIAA standards are as follows: In order to maintain athletic eligibility during the

current semester, the student shall maintain passing grades in a minimum of 5 classes in a

six period schedule. If you are not passing 5 classes, you will be placed on WIAA

ineligible status for the first five (5) weeks of the grading period for that season. This is

not negotiable

An incomplete is treated as an F for purposes of eligibility. Participants remain ineligible until the

incomplete is satisfied or a new eligibility period is reached and courses have been successfully completed.

6. ATTENDANCE REQUIREMENTS

Students must attend at least three consecutive class periods in the day in which they are enrolled, in

order to participate in that day's practice, game, show, contest and/or competition. The only reasons for an

absence to be excused by administration would include: 1.) Medical appointment, 2.) Family emergency

or 3.) Participation in school approved activity. A medical or dentist appointment must be

accompanied by a note from the doctor, dentist, or parent. The athletic department will check the

attendance report to verify and enforce.

7. EQUIPMENT/UNIFORMS

School-owned equipment checked out by a participant in any athletic/activity is his/her responsibility.

The loss or misuse of this equipment will be the financial obligation of the participant. Participants will

not be allowed to continue competition, receive awards, or continue into succeeding activities until the

financial obligation is fulfilled or equipment is returned to its original state.

8. ATHLETIC/ACTIVITY CODE REQUIREMENTS FOR ALL ATHLETIC/ACTIVITY PARTICIPANTS

● Physical Exam I have had a physical exam within the past 2 years and it is on file at the

school.

● Insurance I have adequate insurance coverage, or I will purchase school insurance.

● Risks I am aware that participation in interscholastic athletics may result in accidental

injury which, in some cases, may be serious in nature. I have read the

Concussion, Sudden Cardiac Arrest and Inherent Risks in Athletics

Information Sheets.

● Fees A fee will be charged for each sport. Sport fees will be refunded up to a period

of two weeks should an athlete be cut or quit a team during that time. After that

no refund will take place.

9. Code Violations & Consequences

WIAA Rules:

18.24.0- Use of Illegal Substances – School and WIAA rules and regulation are intended to discourage

the use of alcohol, tobacco, legend drugs, controlled substances and paraphernalia and to encourage the

use of school and community resources. School and community resources should be identified for

students who have had a violation and seek help or who are referred for assessment.

18.24.1- Alcohol and tobacco – Each WIAA member school shall adopt reasonable rules and regulations

pertaining to the use of alcohol or tobacco products that are specific to the middle or high school levels.

18.24.2 -Legend drugs and controlled substances – Penalties for the possession, use or sale of legend

drugs (drugs obtained through prescription, RCW 69.41.020-050) and controlled substances (RCW 69.50)

shall be as follows:

1st Violation – A participant shall be immediately ineligible for interscholastic competition in the current

interscholastic sports program for the remainder of the season. Ineligibility shall continue until the next

sports season in which the participant wishes to participate unless the student accesses the assistance

program outlined in B (below).

An athlete that is found to be in violation of the Legend drugs and controlled substances rule shall have

two options.

A. The athlete will be ineligible for participation in contests for the remainder of that

interscholastic sports season and must meet the school’s requirements in order to be

eligible to compete in the next interscholastic sports season. The school principal will

have the final authority regarding the student’s participation in further interscholastic

sports programs.

B. The athlete may choose to seek and receive help for a problem with use of legend drugs

or controlled substances. Successful utilization of school and or community assistance

programs may allow him/her to have eligibility reinstated in that athletic season, pending

recommendation by the school.

2nd Violation – A participant who again violates any provision of RCW 69.41.020 through 69.41.050 or

of RCW 69.50 shall be ineligible for interscholastic competition for a period of one (1) calendar year

from the date of the second violation.

3rd Violation – A participant who violates for the third time RCW 69.41.020 – 69.41.050 or of RCW

69.50 shall be permanently ineligible for interscholastic competition.

Rules regarding the use, possession, consumption, sharing*, providing*, or distribution of alcohol,

tobacco, e-cigarettes/vapor devices, liquid nicotine and drugs:

1st Violation: In addition to WIAA rulings a student athlete/participant shall be immediately ineligible

for interscholastic competition in the current interscholastic program for the remainder of the season or a

minimum of thirty (30) participation days whichever is greater. Ineligibility shall continue until the next

sports season in which the student athlete wishes to participate. In addition, the participant will complete

a drug/alcohol evaluation by a Certified Chemical Dependency Counselor or join a tobacco cessation

class as approved by the Principal and follow through on any recommendations made by those agencies.

All costs incurred will be the responsibility of the student and/or parent/guardian.

2nd Violation: A student participant who again violates any provision of this code shall be ineligible for

interscholastic competition for a period of one calendar year from the date of the second violation in the

Anacortes School District. In addition, A drug/alcohol re-evaluation will be required by a Certified

Chemical Dependency Counselor, or in the case of tobacco use, enrollment in a second tobacco cessation

class will be required and follow through on any recommendations made by those agencies.

3rd Violation: A student participant who violates this code for a third time shall be permanently

ineligible for interscholastic competition in the Anacortes School District.

Participation day will be defined as any scheduled practice, rehearsal, game, or performance. Rules

regarding the use, possession, consumption, sharing*, providing*, or distribution of alcohol, tobacco,

e-cigarettes/vapor devices, liquid nicotine and drugs:

*Under no circumstances will the penalties be waived for sharing, providing, or distribution.

(Rules regarding the use, possession, consumption, sharing, or distribution of any drugs and

controlled substances, covers grades 7-12, accumulative follows State WIAA policies. Example

of legend drugs are marijuana, designer drugs, cocaine, paraphernalia being used for drugs,

anabolic steroids)

WIAA Legend Drugs & Controlled Substances Policy

Penalties for the possession, use or sale of legend drugs (drugs obtained through prescription, RCW

69.41.020-050) and controlled substances (RCW 69.50). Example of legend drugs are marijuana,

designer drugs, cocaine, paraphernalia being used for drugs, anabolic steroids.

Athletics

Clubs/Activities

Consequence

First Violation

A participant shall be immediately ineligible for interscholastic competition

in the current interscholastic sports program for the remainder of the

season.

In addition, the participant will complete a drug/alcohol evaluation by a

Certified Chemical Dependency Counselor or join a tobacco cessation class

as approved by the Principal and follow through on any recommendations

made by those agencies. All costs incurred will be the responsibility of the

student and/or parent/guardian.

Second Violation

A participant who again violates any provision of RCW 69.41.020 through

69.41.050 or of RCW 69.50 shall be ineligible for interscholastic competition

for a period of one (1) calendar year from the date of the second violation.

In addition, a drug/alcohol re-evaluation will be required by a Certified

Chemical Dependency Counselor, or in the case of tobacco use, enrollment in

a second tobacco cessation class will be required and follow through on any

recommendations made by those agencies.

Third Violation

A participant who violates for the third time RCW 69.41.020 – 69.41.050 or

of RCW 69.50 shall be permanently ineligible for interscholastic

competition.

AHS Alcohol, Tobacco, Nicotine Policy

Use, possession, consumption, sharing*, providing*, or distribution of alcohol, tobacco, e-

cigarettes/vapor devices, liquid nicotine and drugs.

Athletics

Clubs/Activities

Consequence

First Violation

In addition to WIAA rulings a student athlete/participant shall be

immediately ineligible for interscholastic competition in the current

interscholastic program for the remainder of the season or a minimum of

thirty (30) participation days whichever is greater. Ineligibility shall

continue until the next sports season in which the student athlete wishes to

participate. In addition, the participant will complete a drug/alcohol

evaluation by a Certified Chemical Dependency Counselor or join a tobacco

cessation class as approved by the Principal and follow through on any

recommendations made by those agencies.

Second Violation

A student participant who again violates any provision of this code shall be

ineligible for interscholastic competition for a period of one calendar

year from the date of the second violation in the Anacortes School

District. In addition, A drug/alcohol re-evaluation will be required by a

Certified Chemical Dependency Counselor, or in the case of tobacco use,

enrollment in a second tobacco cessation class will be required and follow

through on any recommendations made by those agencies.

Third Violation

A student participant who violates this code for a third time shall be

permanently ineligible for interscholastic competition in the Anacortes

School District.

Note: Out of season code violations will follow AMS consequences.

Proximity is defined as being PRESENT for any amount of time, where the use, possession, consumption,

sharing, and providing of alcohol, marijuana, legend drugs, tobacco, e-cigarettes/vapor devices, liquid

nicotine, drug paraphernalia is occurring.

Documented evidence could include but not limited to police reports, student/staff/citizen reporting,

administration investigations, and social media. All reported incidents will be investigated for validity prior

to consequence being administered.

Rules regarding the use, possession, consumption, sharing*, providing*, or distribution of alcohol,

tobacco, e-cigarettes/vapor devices, liquid nicotine and drugs:

*Under no circumstances will the penalties be waived for sharing, providing, or distribution.

(Rules regarding the use, possession, consumption, sharing, or distribution of any drugs and

controlled substances, covers grades 7-12, accumulative follows State WIAA policies. Example

of legend drugs are marijuana, designer drugs, cocaine, paraphernalia being used for drugs, and

anabolic steroids.

10. STUDENT APPEALS

The Anacortes Middle School Athletic Director will act on all cases involving violations of the Anacortes

Middle School Athletic/Activity Code. Students may appeal decisions affecting their athletic/activity

eligibility. In each case, the student and the Parent(s)/Guardian(s) will be notified of the appeal process at

the time of the suspension in the code violation letter.

STEP ONE: TO THE PRINCIPAL

A. Any student or parent/guardian aggrieved by the decision of the Athletic Director may appeal to

the Principal. Appellant should notify the Principal within three (3) school days. Failure to do so

will render the decision of the Athletic Director final.

B. Following receipt of appeal, the Principal will conduct a meeting of involved parties within three

(3) school days.

C. Within two (2) school days of the conclusion of the meeting, the Principal will notify the student

and parent/guardian of his/her decision.

STEP TWO: TO THE SUPERINTENDENT OR SUPERINTENDENT’S DESIGNEE

A. Any student or parent/guardian aggrieved by the decision of the Principal may appeal to the

Superintendent of the Anacortes School District. Appellant should notify the Superintendent or

his/her designee within three (3) school days. Failure to do so will render the decision of the

Principal final.

B. Following receipt of appeal, the Superintendent or his/her designee will conduct a meeting of

involved parties within three (3) school days.

C. Within two (2) school days of the conclusion of the meeting, the Superintendent will notify the

student and parent/guardian of his/her decision.

STEP THREE: TO THE BOARD OF DIRECTORS

A. Any student or parent/guardian, aggrieved by the decision of the Superintendent, may appeal to

the Board of Directors of the Anacortes School District.

B. Such appeal must be made within three (3) school days of the date of the decision of the

Superintendent. Failure to do so will render the decision of the Superintendent final.

C. The Board will hear the appeal of the involved parties at their next regularly scheduled meeting or

at a special meeting as they determine is necessary.

D. The Board will notify the involved parties within five (5) schools days of their decision.