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Athletic Forms

Please complete the form below. Required fields marked with an asterisk *
Student’s grade for the 2020-21 school year?*
Answer Required
Select Specific Sport:*
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In order to monitor head injuries with the possibility of concussions sustained by our studentathletes, we have acquired a software tool called ImPACT (Immediate Post Concussion Assessment and Cognitive Testing). If an athlete is believed to have suffered a head injury during competition, ImPACT is designed to aid in the determination of the severity of the head injury and when the injury has fully healed. I understand that Paramus Catholic requires this test for participation in the following sports/activities: Basketball, Football, Ice Hockey, Lacrosse, Soccer, Wrestling, Baseball, Cheerleading, Softball, Ultimate Frisbee, Volleyball, and Dance, as well as High Jump and Pole Vault for Track. Student athletes will not be allowed to participate in these sports/events/activities without completing the pre-season baseline test.*
Answer Required
Any student-athlete who is seen by a doctor for a medical condition or injury during the school year, must provide written clearance from a doctor to continue with sports, physical education or other extra-curricular activities.*
Answer Required
I waive any claim against PARAMUS CATHOLIC and THE ARCHDIOCESE OF NEWARK, its agents, employees or representatives for any damages for injuries said child might sustain while participating in above-mentioned sports. I understand I am liable for any expenses incurred for injuries connected with participation in sports which are not covered by any insurance policy which is in force at the time of the injury. I give permission for first aid to be rendered in case of accident to my child and also immediate hospitalization if necessary for emergency treatment at the nearest available hospital.*
Answer Required
We are aware that all athletic activity includes the potential for injury. We acknowledge that even with the best coaching, use of protective equipment and strict observance of rules, injuries are still a possibility. On rare occasions these injuries can be so severe as to result in total disability, paralysis, or even death. We acknowledge that we have read and understand this warning. Parent’s health insurance is primary in case of accident or injury. The Newark Archdiocese purchases a limited secondary insurance policy for all interscholastic sports.*
Answer Required

Family physician to be contacted in case of emergency:

HEALTH HISTORY UPDATE QUESTIONNAIRE

To participate on a school-sponsored interscholastic or intramural athletic team or squad, each student whose physical examination was completed more than 90 days prior to the first day of official practice shall provide a health history update questionnaire completed and signed by the student’s parent or guardian. 

Since the last pre-participation physical examination, has your son/daughter:

1. Been medically advised not to participate in a sport?*
Answer Required
2. Sustained a concussion, been unconscious or lost memory from a blow to the head? *
Answer Required
3. Broken a bone or sprained/strained/dislocated any muscle or joints?*
Answer Required
4. Fainted or “blacked out?”*
Answer Required
5. Experienced chest pains, shortness of breath or “racing heart?”*
Answer Required
6. Has there been a recent history of fatigue and unusual tiredness?*
Answer Required
7. Been hospitalized or had to go to the emergency room?*
Answer Required
8. Since the last physical examination, has there been a sudden death in the family or has any member of the family under age 50 had a heart attack or “heart trouble?”*
Answer Required
9. Started or stopped taking any over-the-counter or prescribed medications?*
Answer Required
10. Been diagnosed with Coronavirus (COVID-19)? *
Answer Required
If diagnosed with Coronavirus (COVID-19), was your son/daughter symptomatic?
Answer Required
If diagnosed with Coronavirus (COVID-19), was your son/daughter hospitalized?
Answer Required
11. Has any member of the student-athlete’s household been diagnosed with Coronavirus (COVID-19)?*
Answer Required
TO BE COMPLETED BY PARENT: *
Answer Required

Sudden Cardiac Death in Young Athletes Acknowledgment

By acknowledging below, we confirm to have read and understand the information in the “Sudden Cardiac Death in Young Athletes” pamphlet.

"Sudden Cardiac Death in Young Athletes” pamphlet can be found on the Medical Forms page under the Athletics heading or by clicking HERE.
TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required

Sports-Related Concussion and Head Injury Fact Sheet

"Sports-Related Concussion and Head Injury Fact Sheet" can be found on the Medical Forms page under the Athletics heading or by clicking HERE.

TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required
NJSIAA STEROID TESTING POLICY CONSENT TO RANDOM TESTING
In Executive Order 72, issued December 20, 2005, Governor Richard Codey directed the New Jersey Department of Education to work in conjunction with the New Jersey State Interscholastic Athletic Association (NJSIAA) to develop and implement a program of random testing for steroids, of teams and individuals qualifying for championship games.
Beginning in the Fall, 2006 sports season, any student-athlete who possesses, distributes, ingests or otherwise uses any of the banned substances on the attached page, without written prescription by a fully-licensed physician, as recognized by the American Medical Association, to treat a medical condition, violates the NJSIAA’s sportsmanship rule, and is subject to NJSIAA penalties, including ineligibility from competition. The NJSIAA will test certain randomly selected individuals and teams that qualify for a state championship tournament or state championship competition for banned substances. The results of all tests shall be considered confidential and shall only be disclosed to the student, his or her parents and his or her school. No student may participate in NJSIAA competition unless the student and the student’s parent/guardian consent to random testing.
By acknowledging below, we consent to random testing in accordance with the NJSIAA steroid testing policy. We understand that, if the student or the student’s team qualifies for a state championship tournament or state championship competition, the student may be subject to testing for banned substances.
TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required
2019-20 NJSIAA Banned Drugs
"2019-20 NJSIAA Banned Drug List" can be found on the Medical Forms page under the Athletics heading or by clicking HERE.
IT IS YOUR RESPONSIBILITY TO CHECK WITH THE APPROPRIATE OR DESIGNATED ATHLETICS STAFF BEFORE USING ANY SUBSTANCE.
TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required
Use and Misuse of Opioid Drugs
In accordance with N.J.S.A. 18A:40-41.10, public school districts, approved private schools for students with disabilities, and nonpublic schools participating in an interscholastic sports program must distribute this Opioid Use and Misuse Educational Fact Sheet to all student-athletes and cheerleaders. In addition, schools and districts must obtain a signed acknowledgement of receipt of the fact sheet from each student-athlete and cheerleader, and for students under age 18, the parent or guardian must also sign.
All student athletes and their parents/guardians must also view the "Athletes vs Opioids" video created by the Office of the New Jersey Coordinator for Addiction Responses and Enforcement Strategies (NJCARES) and the New Jersey State Interscholastic Athletic Association (NJSIAA).
TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required
Sports-Related Eye Injuries
The "Sports-Related Eye Injury" pamphlet can be found on the Medical Forms page under the Athletics heading or by clicking HERE.
TO BE COMPLETED BY PARENT: *
Answer Required
TO BE COMPLETED BY STUDENT: *
Answer Required