Download HIGH SCHOOL SENIOR SPORTS SPECIFIC

MIAMI UNIVERSITY SPORTS MEDICINE HIGH SCHOOL SENIOR SPORTS SPECIFIC EVALUATION
POLICY
Per NCAA 13.11.2.1 On Campus Evaluation bylaw, a prospective student-athlete may participate in an evaluation at
Miami University or on or at a site at which Miami normally conducts practice or competition. Before the prospective
student-athlete is permitted to participate the following information must be submitted to Miami University Sports
Medicine Staff:
a) Before participating in an on-campus evaluation, a prospective student-athlete is required to undergo a
medical examination or evaluation administered or supervised by a physician (e.g., family physician, team
physician).
b) The examination or evaluation shall include a sickle cell solubility test unless documented results of a prior
test are provided to the institution or the prospective student-athlete declines the test and signs a written
release.
c) The examination or evaluation must be administered within six months before participation in the oncampus evaluation and must be submitted on physical examination form.
d) Also, a Miami University Assumption of Risk and Release of Liability Form must be signed by participate
and/or parent/legal guardian if under the age of 18. The form is available at www.MURedhawks.com.
e) All medical documentation and the Miami University Assumption of Risk and Release of Liability Form
should be submitted to Miami University Sports Medicine Staff at least 72 hours prior to the on campus
evaluation.
13.11.2.1 On-Campus Evaluations—Men’s Basketball. In men’s basketball, an institution may conduct an
evaluation of a prospective student-athlete on its campus or at a site at which it normally conducts practice or
competition, under the following conditions: (Adopted: 1/14/12)
f) For a high school or preparatory school senior, the evaluation may be conducted only after the conclusion of the
prospective student-athlete’s season and after he has exhausted high school or preparatory school eligibility in
basketball;
g) For a two-year college prospective student-athlete, the evaluation may be conducted only after the conclusion of
the prospective student-athlete’s season and he has exhausted his two-year college eligibility in basketball;
h) For a four-year college prospective student-athlete, the evaluation may be conducted only after the conclusion of
the prospective student-athlete’s season. (See Bylaw 13.1.1.3);
i)
The on-campus evaluation may be conducted only during the prospective student-athlete’s official or unofficial
visit;
j)
The on-campus evaluation shall be conducted not later than the opening day of classes of the institution’s fall
term;
k) Not more than one on-campus evaluation per prospective student-athlete per institution shall be permitted
(applied separately to the time period in which a prospective student-athlete completes high school or preparatory
school eligibility and to the time period after the prospective student-athlete enrolls full time in a collegiate
institution);
l)
Before participating in an on-campus evaluation, a prospective student-athlete is required to undergo a medical
examination or evaluation administered or supervised by a physician (e.g., family physician, team physician). The
examination or evaluation shall include a sickle cell solubility test unless documented results of a prior test are
provided to the institution or the prospective student-athlete declines the test and signs a written release. The
examination or evaluation must be administered either within six months before participation in the on-campus
evaluation or within six months before the prospective student-athlete’s initial participation in practice,
competition or out-of-season conditioning activities during his immediately completed season. In addition, the
medical examination or evaluation may be conducted by an institution’s regular team physician or other
designated physician as a part of the on-campus evaluation;
m) The institution’s men’s basketball student-athletes may participate in an on-campus evaluation, provided such
participation is counted toward the applicable hourly and weekly limitations on countable athletically related
activities (e.g., four hours per day and 20 hours per week during the playing season, two hours of skill instruction
and eight hours per week outside the playing season). [See Bylaws 17.1.6.2-(a) and 17.1.6.2.2];
n) The duration of the on-campus evaluation activities (other than the medical examination or evaluation) shall be
limited to two hours; and
o) The institution may provide equipment and clothing to a prospective student-athlete on an issuance-and retrieval
basis
MIAMI UNIVERSITY ASSUMPTION OF RISK AND RELEASE OF LIABILITY FORM
I understand that Miami University (“Miami”) is permitting me to be evaluated per NCAA13.11.2.1 On-Campus Evaluations By
Law for potential future participation with Miami University (Sport/Activity) ____________________________________ (for this
form, the term “Activity” shall also include all travel to and from the Activity).
In consideration for being allowed to participate in the Activity, I knowingly and voluntarily:
 acknowledge and understand that my participation in the Activity is entirely voluntary;
 acknowledge that the Activity involves significant physical activity and that there are risks and hazards which may arise from
participation in this Activity
 acknowledge that my participation in the Activity may result in injury (serious and minor), loss of life, and/or loss of property;
 represent that I have had the opportunity to ask any questions that I have about the Activity;
 represent that I am physically and psychologically healthy enough to participate in the Activity;
 acknowledge that any Miami personnel or agents attending the Activity are not necessarily medically trained to care for any
physical or medical problems of individuals participating in the Activity;
 represent that I am financially responsible for any injuries that I may receive as a result of my participation in the Activity, and that
I have adequate health and hospitalization insurance to cover such financial responsibility; and
 agree to follow all the safety rules, procedures and instructions of Miami and the Activity leaders (e.g., appropriate dress, proper
use of safety equipment, etc.) and to avoid unnecessary hazardous situations, whether or not those situations have been specified.
On behalf of myself and my heirs and assigns, I knowingly and voluntarily assume all risks associated with the Activity and release
Miami, its trustees, officers, employees and agents (collectively “Miami Parties”) from any and all responsibility or liability for
personal injury, emotional injury, death or property damage sustained by me during or because of my participation in the Activity. I
agree, for myself, my administrators, personal representatives, executors, predecessors, successors, agents, heirs and assigns to release
and hold harmless the Miami Parties from any present or future claim for personal injury, emotional injury, death or property damage
arising directly or indirectly from my participation in the Activity, to the fullest extent permitted under law, including allegations or
claims of negligence on the part of the Miami Parties, provided, however, this form does not apply to acts of gross negligence, willful
or wanton conduct, or intentional conduct.
I UNDERSTAND AND AGREE THAT BY SIGNING THIS FORM I WILL WAIVE AND FOREVER RELINQUISH ANY AND
ALL CLAIMS THAT I MAY HAVE, WHETHER KNOWN OR UNKNOWN, AND WHETHER ANTICIPATED OR
UNANTICIPATED, AGAINST THE MAIMI PARTIES ARISING OUT OF MY PARTICIPATION IN THE ACTIVITY.
Signature: ________________________________________________
Date: ____________________
Name (Printed):_____________________________________________
Telephone:________________
PARTICIPANTS UNDER THE AGE OF 18 MUST HAVE A PARENTAL OR GUARDIAN COUNTERSIGNATURE
I understand and agree that if I am signing this form on behalf of my minor child, that: (i) I will be giving up the same rights for the
minor as I would be giving up if I signed this document on my own behalf, and (ii) I personally represent and warrant that I am
authorized to sign the form on behalf of the minor.
______________________________
________________________________
Parental/Guardian Signature
Parental/Guardian Name- Printed
Miami University Department of Intercollegiate Athletics
Sickle Cell Trait Testing Information and Waiver Form
Student Athlete Name: ___________________________________
Last
First
Banner ID #: ___________________________
MI
Date of birth: _____/_____/_____
Sickle Cell Trait Testing:
Sickle Cell trait testing involves a simple blood test. People at higher risk for having the sickle cell trait are those of African, South or
Central American, Caribbean, Mediterranean, Indian or Saudi Arabian descent. About 8% of the African-American population has the
sickle cell trait. Sickle cell trait does not mean you have sickle cell anemia and does not prohibit participation in athletics or affect
athletic performance. It does, however, place the student-athlete at higher risk for gross hematuria (blood in the urine), splenic
infarction (chest pain with nausea and vomiting) and exertional rhabdomyolysis (which can be fatal and is exacerbated by
dehydration). Exertional rhabdomyolysis has been linked to sudden death during basic training for the U.S. Armed Forces and the
sudden death of student-athletes.
The NCAA requires that all student-athletes provide proof of testing for the trait, be tested for the trait during the mandatory medical
examination or sign a written release. The NCAA provides educational information regarding sickle cell trait testing which can be
found at NCAA. org(insert link). Miami University encourages testing and encourages student athletes to consult with family
members, including parents and guardians, before making this decision.
Informed Consent for Sickle Cell Trait Testing
I consent to have my blood drawn by the Miami University Student Health Center for the purpose of sickle cell trait testing. I
understand that the results of the test will be shared with the Department of Intercollegiate Athletics, including the Miami University
Sports Medicine, Strength and Conditioning, and coaching staff.
________________________________________________
Signature
Date
______________________________________________
Print Name
Date
________________________________________________
Signature of Parent if under age 18
Date
Prior Testing Within Six Months
I have been tested for the sickle cell trait (had a sickle cell solubility test) within the previous six months and have attached the
documentation of the results of the prior test. I understand that the results of the test will be shared with the Department of
Intercollegiate Athletics, including the Miami University Sports Medicine, Strength and Conditioning, and coaching staff.
_________________________________________________________________________
Signature
Date
_________________________________________________________________________
Print Name
Date
Decline Testing- Waiver of Liability:
I have received and read the information pertaining to sickle cell trait testing. I acknowledge and understand the risks involved
including the risk of sudden death. I decline to receive the sickle cell trait testing.
On behalf of myself and my heirs and assigns, I knowingly and voluntarily assume all risks associated with the decision not to be
tested and release the University, its trustees, officers, employees and agents from any and all responsibility or liability for personal
injury, trauma or death sustained by me during or because of my decision not to be tested or because I have the sickle cell trait. I
UNDERSTAND AND AGREE THAT BY SIGNING THIS FORM, I WAIVE AND FOREVER RELINQUISH ANY AND ALL CLAIMS
THAT I MAY HAVE IN THE FUTURE, WHETHER KNOWN OR UNKNOWN, AND WHETHER ANTICIPATED OR
UNANTICIPATED, ARISING OUT OF MY PARTICIPATION IN THE Intercollegiate Athletic Program as a result of my decision not
to be tested or because I have the sickle cell trait.
I understand and agree that if I am signing this form on behalf of my minor child, that I will be giving up the same rights for the minor
(if student athlete is under 18 years of age) as I would be giving up if I signed this document on my own behalf.
Signature: ___________________________________________________
Name (Printed): _______________________________________________
Parental Co-Signature (if under 18):________________________________
Date: ____________________
Miami University Sports Medicine High School Evaluation Physical Examination Form
Name: __________________________ Date:_____________ Sport: __________________________
Hgt: _________ Wgt: __________ BP: _____________ Pulse: _________
HEENT:
Eyes:______________________________________________________________
___________________________________________________________________
Lungs:_____________________________________________________________
___________________________________________________________________
CV:_______________________________________________________________
___________________________________________________________________
ABD:______________________________________________________________
___________________________________________________________________
Neuro:_____________________________________________________________
___________________________________________________________________
Orthopedic:_________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
_________________________________________________________________
Please circle one that applies:
Cleared
Not Cleared
Cleared Provisionally
Lab: UA GLU: _____ PRO: _____ BLD: _____ KET: _____ CBC WBC: _____ HCT: _____ Hgb: _____
PLT: _____
Notes:______________________________________________________________
___________________________________________________________________
___________________________________________________________________
_________________________________ MD/DO
Signature