Download Liberty Middle School Softball - Edwardsville School District 7

Liberty Middle School
Panthers Softball 2014
Tryouts: Wednesday, July 30th
& Thursday, July 31st
8:00-10:00 am at Liberty Softball Field
All 6th, 7th, and 8th graders trying out for the Liberty Softball Team need to have an
updated physical, extracurricular form and concussion form on file at Liberty
Middle School before tryouts begin. These forms are available from the front office
at Liberty and can also be found on the Liberty Athletics Webpage.
Players trying out for the team need to bring their softball equipment and water
bottle. Liberty softball has two teams- an A and B team. Each team has their own
schedule. This season’s tentative schedules are attached.
Even though the softball season starts in the summer, it is still considered a
school sport. It should be considered a priority. Practices are not optional. If you
have conflicts during the season, please let Coach Bray know in advance.
Information has been included in this packet regarding the EHS Softball Summer
Camp June 16-18 and the EHS Softball/Basketball Boosters Golf Tournament on
Friday, August 1.
If you have any questions, you can e-mail me at [email protected] or call/text
618-580-0449.
Thank you,
Coach Bray
Lady Tiger Softball Camp
Edwardsville Sports Complex
Fundamentals Skills Camp
Coach Lori Blade will be conducting a fundamentals softball camp at the Edwardsville Sports Complex
June 16-17-18. Instruction will be provided in all aspects of the game including fielding, throwing, hitting, bunting, base
running, defensive and offensive strategies. Lady Tiger Softball T-Shirt will be provided!! Please bring:
glove, shoes, cleats, bats etc. In case of rain the camp will be at the high school.
Pitching Instruction
Following the fundamentals skills camp an additional 45-minute session will be held for players interested in specific
instruction for pitching.
The camp will be conducted in three sessions according to Entering Grade for the 2014-2015 school year.
Fundamentals Camp
Entering
Grade (14-15)
Time
Cost
2nd – 3rd – 4th
7:45 – 9:15
$ 55
Fundamental Camp
5th – 6th
9:30 – 11:30
$ 65
Fundamentals Camp w/P/C
5th – 6th
11:30 – 12:15
$ 95
Fundamentals Camp
7th – 8th – 9th
12:45 – 2:45
$ 65
Fundamentals Camp w/P/C
7th – 8th - 9th
2:45 – 3:30
$ 95
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Please fill out the information below and return or mail to EHS TIGER SOFTBALL CAMP, attention Lori Blade, 6161 Center
Grove Rd., Edwardsville, IL. 62025 Fundamental camp sessions will be limited to 60 campers. Registration Deadline Mon. June
16, 2013.
>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>
Name: ____________________ Grade (14-15)_______________ School ___________________
Parent Name: __________________________________________
Address: _____________________________________ Telephone ________________________
Emergency Contact & Phone # _______________________________________________________
Please Circle T-Shirt
Size : Youth
S
M
L
Adult:
S
M
L
I will attend: Circle one.
2nd - 3rd – 4th
Fundamentals Skills Camp:
$ 55.00 (includes Tiger Softball T-Shirt)
5th – 6th
Fundamentals Skills Camp
$ 65.00
5th – 6th
Fundamentals Skills Camp w/P
$ 95.00
7th – 8th – 9th
Fundamentals Skills Camp
$ 65.00
7th – 8th – 9th
Fundamentals Skills Camp w/P
$ 95.00
Make Checks Payable to : EHS Softball Camp
XL
March 2014
Dear EHS Girls Basketball / Softball Supporter,
The Edwardsville High School Girls Softball & Basketball Boosters are having
a golf tournament at Sunset Hills Country Club on Friday August 1, 2014 to raise
funds for the Girl’s Programs.
We are seeking teams to play in the tournament as well as hole sponsors
and prize donations. Thanks to your generous support, the EHS Girls Softball and
Basketball teams have been able to participate in summer tournaments and are
playing in top-notch facilities. We have had many successful seasons and are proud
of the fact that we have become one of the top programs in the state. The money we
are raising at this event is going towards our facilities, uniforms, equipment, summer
programs and travel expenses during the season. We are asking you to help the
girls toward another great season of softball and basketball in 2014.
The tournament is open to all golfers and will be a four person scramble
format. The EHS Girls Softball and Basketball teams will be there to assist the golfers
in any way possible.
If you have any questions or would like someone to pick up a prize donation
please contact Amy Green @ 618-978-1225 or Jim Daech @ 618-779-7354;
[email protected].
The EHS Girls Softball & Basketball Teams Thank You for your
consideration and support of our teams!
Edwardsville High School Girls Softball & Basketball
Boosters Golf Tournament
Friday, August 1, 2014
Sunset Hills Country Club
Edwardsville, Illinois
4 Person Scramble Format
Great Prizes
Shot-Gun start at 8:00 am
Awards and Lunch Immediately
Following Play
Registration Fee Includes:
18 Holes of Golf with Cart, Lunch and Beverages
also a chance to win
Attendance Prizes, Longest Drive Contest, Closest to the Pin Contest,
Great Tournament Prizes,
and other Fun on Course Games!!
If you have any questions or would like someone to pick up a prize donation please call
Amy Green @ 618-978-1225 or Jim Daech @ 618-779-7354.
_________________________________________________________________________________
Secured by (Athlete / Sport): _____________________
Gold Sponsorship includes 2 foursomes and 2 hole advertisements
Silver Sponsorship includes 1 foursome and 1 hole advertisement
Foursome $360.00 or $90.00 for Individuals
Gold Sponsor ______at $1,000.00 $_____________
Silver Sponsor ______at $500.00 $_____________
Hole Sponsor _______at $200.00 $_____________
Prize Donation______________________________
(Prize or $ amount)
Detach and send with check or prize donation to:
Amy Green
604 Jamie Lynn Ct
Edwardsville, IL 62025
Make checks payable to:EHS Girls SB & BB Golf Tourney
Players
_________ at $90.00/player $_________
Mulligans _________ at $ 5.00/player $_________
Skins Are $20.00/Team ----------------- $_________
(100% payout)
Lunch (Non-Golfers)___at $15.00/person $_______
TOTAL AMOUNT DUE $__________________
***OPTIONAL – If you are not golfing but would like to join us for lunch
after the Tournament -Lunch Can Be Provided For Non-Golfers for $15.00/ Person
Hole Sponsor
Scramble Team
Contributor___________________________________
Name_________________________ Phone_________
(Name as to appear on sign)
Contact Name_________________________________
Address______________________________________
Phone __________________________
Name_________________________ Phone_________
Name_________________________ Phone_________
Name_________________________ Phone_________
Pre-participation Examination
To be completed by athlete or parent prior to examination.
Name
School Year
Last
First
Middle
Address
Phone No.
City/State
Birthdate
Age
Class
Student ID No.
Parent’s Name
Phone No.
Address
City/State
HISTORY FORM
Medicines and Allergies: Please list all of the prescription and over-the-counter medicines and supplements (herbal and nutritional) that you are currently taking
Do you have any allergies?
 Yes
 No
If yes, please identify specific allergy below.
 Medicines
 Pollens
Explain “Yes” answers below. Circle questions you don’t know the answers to.
GENERAL QUESTIONS
1. Has a doctor ever denied or restricted your participation in sports
for any reason?
2. Do you have any ongoing medical conditions? If so, please identify
below:  Asthma  Anemia  Diabetes  Infections
Other: _
__________
3. Have you ever spent the night in the hospital?
4. Have you ever had surgery?
HEART HEALTH QUESTIONS ABOUT YOU
5. Have you ever passed out or nearly passed out DURING or AFTER
exercise?
6. Have you ever had discomfort, pain, tightness, or pressure in your
chest during exercise?
7. Does your heart ever race or skip beats (irregular beats) during
exercise?
8. Has a doctor ever told you that you have any heart problems? If
so, check all that apply:  High blood pressure  A heart murmur
 High cholesterol  A heart infection  Kawasaki disease
Other: ___
______
9. Has a doctor ever ordered a test for your heart? (For example,
ECG/EKG, echocardiogram)
10. Do you get lightheaded or feel more short of breath than
expected during exercise?
11. Have you ever had an unexplained seizure?
12. Do you get more tired or short of breath more quickly than your
friends during exercise?
HEART HEALTH QUESTIONS ABOUT YOUR FAMILY
13. Has any family member or relative died of heart problems or had
an unexpected or unexplained sudden death before age 50
(including drowning, unexplained car accident, or sudden infant
death syndrome)?
14. Does anyone in your family have hypertrophic cardiomyopathy,
Marfan syndrome, arrhythmogenic right ventricular
cardiomyopathy, long QT syndrome, short QT syndrome, Brugada
syndrome, or catecholaminergic polymorphic ventricular
tachycardia?
15. Does anyone in your family have a heart problem, pacemaker, or
implanted defibrillator?
16. Has anyone in your family had unexplained fainting, unexplained
seizures, or near drowning?
BONE AND JOINT QUESTIONS
17. Have you ever had an injury to a bone, muscle, ligament, or
tendon that caused you to miss a practice or a game?
18. Have you ever had any broken or fractured bones or dislocated
joints?
19. Have you ever had an injury that required x-rays, MRI, CT scan,
injections, therapy, a brace, a cast, or crutches?
20. Have you ever had a stress fracture?
21. Have you ever been told that you have or have you had an x-ray
for neck instability or atlantoaxial instability? (Down syndrome or
dwarfism)
22. Do you regularly use a brace, orthotics, or other assistive device?
23. Do you have a bone, muscle, or joint injury that bothers you?
24. Do any of your joints become painful, swollen, feel warm, or look
red?
25. Do you have any history of juvenile arthritis or connective tissue
disease?
Yes
No
Yes
No
Yes
No
Yes
No
 Food
 Stinging Insects
MEDICAL QUESTIONS
26. Do you cough, wheeze, or have difficulty breathing during or after
exercise?
27. Have you ever used an inhaler or taken asthma medicine?
28. Is there anyone in your family who has asthma?
29. Were you born without or are you missing a kidney, an eye, a
testicle (males), your spleen, or any other organ?
30. Do you have groin pain or a painful bulge or hernia in the groin
area?
31. Have you had infectious mononucleosis (mono) within the last
month?
32. Do you have any rashes, pressure sores, or other skin problems?
33. Have you had a herpes or MRSA skin infection?
34. Have you ever had a head injury or concussion?
35. Have you ever had a hit or blow to the head that caused
confusion, prolonged headache, or memory problems?
36. Do you have a history of seizure disorder?
37. Do you have headaches with exercise?
38. Have you ever had numbness, tingling, or weakness in your arms
or legs after being hit or falling?
39. Have you ever been unable to move your arms or legs after being
hit or falling?
40. Have you ever become ill while exercising in the heat?
41. Do you get frequent muscle cramps when exercising?
42. Do you or someone in your family have sickle cell trait or disease?
43. Have you had any problems with your eyes or vision?
44. Have you had any eye injuries?
45. Do you wear glasses or contact lenses?
46. Do you wear protective eyewear, such as goggles or a face shield?
47. Do you worry about your weight?
48. Are you trying to or has anyone recommended that you gain or
lose weight?
49. Are you on a special diet or do you avoid certain types of foods?
50. Have you ever had an eating disorder?
51. Have you or any family member or relative been diagnosed with
cancer?
52. Do you have any concerns that you would like to discuss with a
doctor?
FEMALES ONLY
53. Have you ever had a menstrual period?
54. How old were you when you had your first menstrual period?
55. How many periods have you had in the last 12 months?
Yes
No
Yes
No
Explain “yes” answers here
I hereby state that, to the best of my knowledge, my answers to the above questions are complete and correct.
Signature of athlete
Signature of parent/guardian
Date
©2010 American Academy of Family Physicians, American Academy of Pediatrics, American College of Sports Medicine, American Medical Society for Sports Medicine, American Orthopaedic Society for Sports Medicine, and American Osteopathic Academy of Sports
Medicine. Permission is granted to reprint for noncommercial, educational purposes with acknowledgment. HE0503
Pre-participation Examination
PHYSICAL EXAMINATION FORM
Name
Last
First
Middle
EXAMINATION
Height
BP
/
(
Weight
/
)
Pulse
 Male
 Female
Vision R 20/
MEDICAL
Appearance
• Marfan stigmata (kyphoscoliosis, high-arched palate, pectus excavatum,
arachnodactyly, arm span > height, hyperlaxity, myopia, MVP, aortic insufficiency)
Eyes/ears/nose/throat
 Pupils equal
 Hearing
Lymph nodes
Heart a
 Murmurs (auscultation standing, supine, +/- Valsalva)
 Location of point of maximal impulse (PMI)
Pulses
 Simultaneous femoral and radial pulses
Lungs
Abdomen
Genitourinary (males only)b
Skin
 HSV, lesions suggestive of MRSA, tinea corporis
Neurologic c
MUSCULOSKELETAL
Neck
Back
Shoulder/arm
Elbow/forearm
Wrist/hand/fingers
Hip/thigh
Knee
Leg/Ankle
Foot/toes
Functional
 Duck-walk, single leg hop
L 20/
Corrected
NORMAL
Y
N
ABNORMAL FINDINGS
Consider ECG, echocardiogram, and referral to cardiology for abnormal cardiac history or exam.
Consider GU exam if in private setting. Having third party present is recommended.
Consider cognitive evaluation or baseline neuropsychiatric testing if a history of significant concussion.
a
b
c
On the basis of the examination on this day, I approve this child’s participation in interscholastic sports for 395 days from this date.
Yes
No
Limited
Examination Date
Additional Comments:
Physician’s Signature
Physician’s Name
Physician’s Assistant Signature*
PA’s Name
Advanced Nurse Practitioner’s Signature*
ANP’s Name
*effective January 2003, the IHSA Board of Directors approved a recommendation, consistent with the Illinois School Code, that allows Physician’s Assistants or
Advanced Nurse Practitioners to sign off on physicals.
IHSA Steroid Testing Policy Consent to Random Testing
(This section for high school students only)
2013-2014 school term
As a prerequisite to participation in IHSA athletic activities, we agree that I/our student will not use performance-enhancing substances as defined in the
IHSA Performance-Enhancing Substance Testing Program Protocol. We have reviewed the policy and understand that I/our student may be asked to
submit to testing for the presence of performance-enhancing substances in my/his/her body either during IHSA state series events or during the school
day, and I/our student do/does hereby agree to submit to such testing and analysis by a certified laboratory. We further understand and agree that the
results of the performance-enhancing substance testing may be provided to certain individuals in my/our student’s high school as specified in the IHSA
Performance-Enhancing Substance Testing Program Protocol which is available on the IHSA website at www.IHSA.org. We understand and agree that
the results of the performance-enhancing substance testing will be held confidential to the extent required by law. We understand that failure to provide
accurate and truthful information could subject me/our student to penalties as determined by IHSA.
A complete list of the current IHSA Banned Substance Classes can be accessed at
http://www.ihsa.org/initiatives/sportsMedicine/files/IHSA_banned_substance_classes.pdf
Signature of student-athlete
Date
Signature of parent-guardian
Date
SPORTS/ACTIVITY ____________________
Physical Date ______________
Edwardsville Community Unit School District 7_________________________________
Dr. Ed Hightower, Superintendent
IMPORTANT: ALL REQUESTED INFORMATION MUST BE COMPLETED AND
SUBMITTED TO THE SPONSOR OR ATHLETIC OFFICE PRIOR TO PARTICIPATION.
PARTICIPANTS WILL NOT UNDER ANY CIRCUMSTANCES BE ALLOWED TO TAKE
PART IN PRACTICES, COMPETITIONS, OR ACTIVITIES WITHOUT COMPLETION OF
THIS FORM.
2014-15 ATHLETICS/EXTRACURRICULAR ACTIVITY
MEDICAL AUTHORIZATION FORM
Student’s Name______________________________________________________________
EMERGENCY PHONE NUMBERS:
Day:
Father______________ Mother_______________ Friend__________
Evening/Night:
Home______________ Other_________________
MEDICATION INFORMATION:
1. Is student taking medication on a regular basis?
Yes  No 
Name of medication__________________________________________________________
Dosage____________________________________________________________________
Reason for medication________________________________________________________
2. Is your child allergic to any medications?
Yes  No 
If yes, which?_____________________________________________________________
3. When was your child’s last tetanus shot? Date__________
4. Are there any medical or physical problems of which we need be aware?______________
_________________________________________________________________________
5. If given a preference, what hospital would you like your child taken for treatment in the event of a
medical emergency? ________________________
In case of emergency and a parent cannot be reached by phone, I authorize any teacher/sponsor to obtain
medical treatment for my son/daughter ______________________________________.
(Child’s Name)
Insurance Company__________________________________
Name of Insured_____________________________________
Policy Number_____________
Group Number_____________
Name of Child’s Physician __________________
Phone Number _____________
I understand that as the parent/guardian of the above-named student, I am responsible for medical
expenses incurred. I certify that the above information is accurate and complete and is required for my
child to participate in the sport/activity.
Date:_________________
Parent’s Signature__________________
______________________________________________________________________________
708 St. Louis Street
www.ecusd7.org
618.656.1182
Edwardsville, IL 62025
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.
Symptoms may include one or more of the following:











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/comment
Signs observed by teammates, parents and coaches include:














Appears dazed
Vacant facial expression
Confused about assignment
Forgets plays
Is unsure of game, score, or opponent
Moves clumsily or displays in 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 change in typical behavior or personality
Loses consciousness
Adapted from the CDC and the 3rd International Conference on Concussion in Sport
Document created 7/1/2012
Concussion Information Sheet
What can happen if my child keeps on playing with a concussion or returns too
soon?
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 fail to report symptoms of injuries.
Concussions are no different. As a result, education of administrators, coaches, parents
and students is the key to 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 Return-to- Play Policy of the IESA and IHSA requires athletes to provide
their school with written clearance from either a physician licensed to practice medicine
in all its branches or a certified athletic trainer working in conjunction with a physician
licensed to practice medicine in all its branches prior to returning to play or practice
following a concussion or after being removed from an interscholastic contest due to a
possible head injury or concussion and not cleared to return to that same contest. In
accordance with state law, all schools are required to follow this policy.
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/
_____________________________
Student-athlete Name Printed
_____________________________
Student-athlete Signature
_____________
Date
__________________________
Parent or Legal Guardian Printed
___________________________
Parent or Legal Guardian Signature
___________
Date
Adapted from the CDC and the 3rd International Conference on Concussion in Sport
Document created 7/1/2012