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IMPORTANT: This form must be filled out and submitted to the Blanchet Catholic School athletic office before a student can participate in athletics.
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In case of an emergency involving my student at an athletic event, contact parents or call the emergency person listed below:
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INSURANCE
Students participating in athletics are required to be covered by medical insurance, either by a family plan or one that is available through Blanchet. Blanchet has selected the student insurance plan from KandKInsurance (choose Blanchet School from the choices) to make reliable coverage available to parents. Coverage may be purchased at any time during the school year.
Any change in medical insurance between sports seasons must be reported.
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PHYSICAL EXAMINATION REQUIREMENT
State law requires students in grade 6-12 participating in school athletics to get a physical every two (2) years - every one (1) year for football athletes. The OSAA examination form must be on file in the school office. If the student has had any serious accident, illness, or injury since the last physical examination, a physician’s clearance is necessary.
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ImPACT Registration and Permissions Form
ImPACT cognitive testing is offered for high school and mid high sports.
The computerized exam is given to student-athletes before beginning contact sport practice or competition. This non-invasive test is set up in “video-game” type format and takes about 20-25 minutes to complete. It is simple, and actually many athletes enjoy the challenge of taking the test. Essentially, the ImPACT test is a preseason physical of the brain. It tracks information such as memory, reaction time, speed, and concentration. It, however, is not an IQ test.
Blanchet Catholic School recognizes the importance of tools like this to collect data and help assess concussions when they happen. The Blanchet administration, coaching, and athletic training staffs are striving to keep your child’s health and safety at the forefront of the student-athletic experience.
With all this said, parents have the option to opt-out of this testing, but must complete this form to do so. Students will receive an email with a link and test code. Please provide your student with 30 minutes of quiet in a distraction free area.
CONSENT FOR ImPACT COGNITIVE TESTING AND RELEASE OF INFORMATION
I understand that the Blanchet Catholic School Athletic Department will use this program to provide my treating physician with the best available information for managing concussions. I understand the test procedures and the purpose of baseline/post injury testing. I am aware that the information gathered will be used for the sole purpose of injury management under the direction of a treating physician.
Based on the information provided, I give my child permission to take part in baseline testing. In the event that a treating physician requests post-injury ImPACT test(s), I give my child permission to take these post-injury ImPACT Tests. I authorize the release of the baseline and post-injury ImPACT Test results to the treating physician.
I understand that in the event of an injury, general information about my child’s condition may be given to my child’s advisor, counselor, school administrator, school health professionals, learning specialist, and/or teachers for the purposes of providing temporary academic modifications, if necessary, but that no specific test results will be shared.
OPT-OUT FOR ImPACT COGNITIVE TESTING
I acknowledge the information regarding the ImPACT Concussion Management Program.
I decline the opportunity to allow my child to participate at this time. My child will not receive a baseline ImPACT test and will not have access to post-injury testing. I will contact the Blanchet Athletic Department to schedule a convenient test date if I wish to have my child participate in the future.
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