Parent/Guardian Name

Street Address

City

State and Zip Code

Phone Number

Email address

I, the parent or legal guardian, give permission for the children listed below, to attend and participate in guest athletic activity (camp, clinic, drop-in, open gym, etc.) sponsored by the Traverse City Bulldog Athletic Association. I understand that this activity requires physical exertion and carries inherent risks of injury. 

I understand this permission applies only to this guest event and does not enroll my family in regular TCBAA team sports or programs. Team sports require separate approval and the annual family participation fee.

NAMES AND BIRTHDATES OF PARTICIPATING CHILDREN:

Event for Guest Participation

If selecting Other Event above, please specify:

PARENT AUTHORIZATION, ATHLETIC WAIVER & RELEASE - For Guest Athletic Activities, Camps, and Drop-In Sessions

WARNING STATEMENT TO STUDENTS AND PARENTS

Serious, Catastrophic, and Perhaps Fatal Injury May Result from Athletic Participation

By its nature, competitive athletics may put students in situations where serious, catastrophic, and perhaps fatal accidents may occur.

Many forms of athletic competition result in violent physical contact among players, the use of sports equipment that may result in accidents, strenuous physical exertion, and numerous other exposures of risk of injury.

Students and parents must assess the risks involved in such participation and make their choice to participate in spite of those risks. No amount of instruction, precaution, or supervision will totally eliminate all risk of injury. Just as driving an automobile involves a choice of risk, athletic participation may also be inherently dangerous. The obligation of parents and students in making this choice to participate cannot be overstated. There have been accidents resulting in death, paraplegia, quadriplegia, and other very serious physical impairment as a result of athletic competition.

The risk assumed includes injury resulting from the negligence of other student-athletes and participants, and the TCBAA supervision of its athletic program cannot prevent negligent conduct by all participants at all times.

By granting permission for your student to participate in athletic competition, you, the parent or guardian, acknowledge that such risk exists.

Students will be instructed in proper techniques to be used in athletic competition and in the proper utilization of all equipment worn or used in practice and competition. Students must adhere to that instruction and utilization and refrain from improper uses and techniques.

The students are responsible for immediately informing the coach or other supervising TCBAA personnel of any physical or medical condition that might affect the safety of their participation in the athletic program.

ATHLETIC CONSENT AND WAIVER OF LIABILITY

I, the parent or legal guardian, have read the Warning Statement to Students and Parents. I understand that these risks are present in any and all sports. With full knowledge of the warning statement, I am giving my permission and consent for my child or children to participate in all sports offered by the Athletic program of the Traverse City Bulldog Athletic Association.

I agree to release Traverse City Bulldog Athletic Association, its officials, directors, employees, and coaching staff from any and all liability arising out of my child or children’s participation in the athletic program, including liability for injuries caused by the negligent conduct of any persons involved in the program.

Physician/Doctor's Name

Doctor's Phone Number

Health Insurance Company

Policy/Group Number

Primary Insured's Name

MEDICAL AUTHORIZATION AND WAIVER OF LIABILITY

I, the parent or legal guardian, understand that athletic activities carry risks of serious injury. In the event my child is injured during the TCBAA guest event, camp, or drop-in session, I authorize the coach or appropriate TCBAA official to render first aid and/or secure medical treatment, including emergency transport to a hospital if necessary.

I agree to release the Traverse City Bulldog Athletic Association, its officials, directors, employees, coaching staff, and any medical personnel from any liability arising from first aid rendered and/or medical treatment secured in connection with my child’s participation in this event.

PHOTO & MEDIA RELEASE FORM

Participation in any TCBAA program requires Full Photo & Media Consent.

I hereby grant the Traverse City Bulldogs Athletic Association full permission to use photographs, videos, and other media of my family taken during sports programs for promotional, educational, and organizational purposes (including website, social media, newsletters, team photos, etc.)  I also acknowledge that other members, spectators, visitors, and other teams will occasionally take photos and videos of our teams and understand that TCBAA cannot control their use of such media.

UNDERSTANDING CONCUSSION

Some Common Symptoms

IF YOU SUSPECT A CONCUSSION:

1. SEEK MEDICAL ATTENTION RIGHT AWAY – A healthcare professional will be able to decide how serious the concussion is and when it is safe for the student to return to regular activities, including sports. Don’t hide it; report it. Ignoring symptoms and trying to “tough it out” often makes it worse.

2. KEEP YOUR STUDENT OUT OF PLAY – Concussions take time to heal. Don’t let the student return to play the day of injury and until a health care professional says it’s okay. A student who returns to play too soon while the brain is still healing risks a greater chance of having a second concussion. Young children and teens are more likely to get a concussion and take longer to recover than adults. Repeat or second concussions increase the time it takes to recover and can be very serious. They can cause permanent brain damage, affecting the student for a lifetime. They can be fatal. It is better to miss one game than the whole season.

3. TELL THE SCHOOL ABOUT ANY PREVIOUS CONCUSSION – Schools should know if a student had a previous concussion. A student’s school may not know about a concussion received in another sport or activity unless you notify them.

SIGNS OBSERVED BY PARENTS:

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

CONCUSSION DANGER SIGNS:

In rare cases, a dangerous blood clot may form on the brain in a person with a concussion and crowd the brain against the skull. A student should receive immediate medical attention if, after a bump, blow, or jolt to the head or body, s/he exhibits any of the following danger signs:

• One pupil larger than the other
• Is drowsy or cannot be awakened
• A headache that gets worse
• Weakness, numbness, or decreased coordination
• Repeated vomiting or nausea
• Slurred speech
• Convulsions or seizures
• Cannot recognize people/places
• Becomes increasingly confused, restless or agitated
• Has unusual behavior
• Loses consciousness (even a brief loss of consciousness should be taken seriously.)

HOW TO RESPOND TO A REPORT OF A CONCUSSION:

If a student reports one or more symptoms of a concussion after a bump, blow, or jolt to the head or body, s/he should be kept out of athletic play the day of the injury. The student should only return to play with permission from a health care professional experienced in evaluating for concussion. During recovery, rest is key. Exercising or activities that involve a lot of concentration (such as studying, working on the computer, or playing video games) may cause concussion symptoms to reappear or get worse. Students who return to school after a concussion may need to spend fewer hours at school, take rest breaks, be given extra help and time, and spend less time reading, writing, or on a computer. After a concussion, returning to sports and school is a gradual process that should be monitored by a healthcare professional.

Remember: Concussion affects people differently. While most students with a concussion recover quickly and fully, some will have symptoms that last for days or even weeks. A more serious concussion can last for months or longer.

To learn more, go to www.cdc.gov/heads-up.

CONCUSSION AWARENESS

EDUCATIONAL MATERIAL ACKNOWLEDGEMENT FORM

By responding below, I acknowledge in accordance with Public Acts 342 and 343 of 2012 that our family has received and reviewed the Concussion Fact Sheet for Parents and/or the Concussion Fact Sheet for Students provided by Traverse City Bulldogs Athletic Association, the Sponsoring Organization.  

Name

Relationship

Phone Number

Upon submitting this form to participate with the Traverse City Bulldogs Athletic Asssociation, I confirm that I, the parent or legal guardian of the children listed above, have fully read and understand these items as agreed upon above:

• Parent Authorization, Athletic Waiver & Release
• Medical Authorization & Waiver of Liability
• Photo & Media Release Form
• Educational Material on Concussion Awareness