Player Profile Sheet Player Profile Sheet Step 1 of 4 25% Player InformationPlayer Name* First Last Student #*Date of birth*Year201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950194919481947194619451944194319421941194019391938193719361935193419331932193119301929192819271926192519241923192219211920Month123456789101112Day12345678910111213141516171819202122232425262728293031Place of birth*Gender*MaleFemaleHeight (ft' in")*in feet and inchesWeight (lbs)in poundsAcademic Program*Arts and SciencesALC - MediaALC - MultidisciplinaryALC - LanguagesALC - TheatreALC - LiteratureDouble Dec: Science & Social ScienceHonours ScienceLiberal ArtsScienceSocial ScienceSocial Science w/ MathematicsSocial Science w/ CommerceSocial Science w/ PsychologyVisual ArtsBiopharmaceutical Production TechnologyBusiness AdministrationComputer ScienceDental HygieneEngineering TechnologiesInformation & Library TechnologiesNursingNursing (Post-DEP)Police TechnologyPre-Hospital Emergency CareProfessional TheatrePublication Design & Hypermedia TechnologiesYouth & Adult Correctional InterventionPathways to a CareerPathways to Police TechnologyPathways to ScienceOther1st SemesterFallWinter:EstimatedFallWinterGraduation:Sport*BaseballBasketball - MenBasketball - WomenCheerleadingFlag FootballFootballGolfHockeyLacrosseRugby - MenRugby - WomenSoccer - MenSoccer - WomenSwimmingVolleyball - MenVolleyball - WomenX-Country RunningIs this your first year as an Islander?*YesNoContact InformationPermanent Address* Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Is your current address the same as your permanent address?*YesNoCurrent Address Street Address City AlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukon Province Postal Code Home Phone #*Cell #Email Address* Do you plan on living in residence or nearby?Mother's name* First Last Father's name* First Last Player HistoryHave you attended another CEGEP or College?YesNoName of institutionFromToHigh school attended*Year of Graduation*Academic AveragePlease enter a value between 0 and 100.Team previously played for (list the most recent)TeamHead CoachFromTo Medical InformationProvincial Insurance Number (Medicare)*Expiry Date* ProvinceAlbertaBritish ColumbiaManitobaNew BrunswickNewfoundland & LabradorNorthwest TerritoriesNova ScotiaNunavutOntarioPrince Edward IslandQuebecSaskatchewanYukonFamily PhysicianPhoneMedical Conditions (check all that apply) Anemia Asthma Diabetes Epilepsy Kidney Disease Mononucleosis Skin Problems Other Please SpecifyAllergies Medications Primary Insurance CompanyPolicy NumberPhoneEmergency Contact* First Last Phone*Medical HistoryList past medical illnesses or injuries or hospitalizations List previous sprains, strains or swelling of your joints List past surgeries and dates List any supplements taken within the past 6 months If you answer Yes to any of the following questions, please explainHave you ever passed out during or after exercise?YesNoExplain Have you ever been dizzy, had chest pain, a racing heart beat during or after exercise?YesNoExplain Have you ever been told you have a heart murmur?YesNoExplain Has any family member or relative died of heart problems or sudden death before the age of 50?YesNoExplain Have you ever had chest pain, felt dizzy or lost consciousness when you were not doing physical activity?YesNoExplain Have you ever become ill from exercising in the heat?YesNoExplain Have you ever had a head injury, been dinged or had a concussion? If yes, how many (list dates of injury, and how long it took you to recover)?YesNoExplain Are you still experiencing symptoms from a head injury?YesNoExplain Have you ever been in a car accident?YesNoExplain Do you have frequent or severe headaches?YesNoExplain Do you ever cough, wheeze or have trouble breathing during or after exercise?YesNoExplain Have you ever had numbness or tingling in your arms, hands, legs or feet, or had a stinger, burner or pinched nerve?YesNoExplain Have you ever had any loss of paired organ? (eye, ear, kidney, lung, testicle or ovary)YesNoExplain Do you have any current skin problems? (rashes, blisters, etc.)YesNoExplain Do you wear contact lenses or glasses?YesNoExplain Are your periods regular? what was the longest time between your periods in the last year?YesNoExplain Medical UpdateIn the past year, have you been hospitalized for any reason?YesNoProvide details.* In the past year, have you gone to the emergency room for any reason?YesNoProvide details.* In the past year, have you injured yourself such that you needed to see a doctor, required therapy treatments or missed time from school, practice or games?YesNoProvide details.* In the past year, have you had a head injury, been dinged or had a concussion?YesNoProvide details.* In the past year, have you been in a car accident?YesNoProvide details.* Student Athlete Obligations Contract 2016-2017 Your first step to making a full commitment to your team, teammates, coaches, the Sports and Recreation Department and John Abbott College is to carefully READ, SIGN, and fulfill the expectations of this agreement. As a Student-Athlete, it is a privilege to participate in an intercollegiate sport. As such, you must demonstrate your commitment to your athletic program by regularly attending practices and competitions and by adhering to the following provisions. STUDENT-ATHLETE RESPONSIBILITIES To have a genuine commitment to your academics and not simply meet league and college eligibility requirements. To meet with your Academic Coach every two weeks (unless decided otherwise between you and your AC) when school is in session. To provide teachers with absentee notification a week before your absence when unable to attend class (e.g. because of sports-related injury), required class outings or when departing early for competition; you are responsible for all work, class commitments that occurred during your absence. To promptly discuss dropping or adding courses at any point during the semester with your Acamedic Coach and then consulting the Sports and Recreation Deparment as these actions may affect your eligibility (you must maintain full time status at the college). To authorize the access of your transcript and the contact of any current teachers (either by your AC or the Sports and Recreation department) for all questions pertaining to academic performance, results. To attend and be punctual for ALL practices and competitions. To represent your team and college in a responsible manner at all times while at competitions, when in the classroom and throughout your CEGEP career. Complete 5 hours of community service before April 1st, 2017. It is a privilege to participate in an intercollegiate sport and giving back to the community is an important part of that role. For information on the types of activities that are eligible, visit the Sports and Recreation Department. DRUG AWARENESS COMMITMENT The student-athlete commits to attending and alcohol/drug awareness and performance enhancing drugs workshop. SANCTIONS: Sanctions will be enforced for student-athletes who fail to meet these obligations. These may range from a game suspension in the case of a missed appointment to larger sanctions in the case of repeated dereliction of duty, including expulsion from the athletic program. If a student-athlete is expulsed from the program, quits or has a season ending injury, they are not entitled to a refund of their fees and are committed to pay any fees associated with merchandise or services they received. I have read and understood the terms and conditions outlined in the above Student-Athlete Obligations Contract. Consent for Transmittal & Certificate of InformationPrint this page before you submit it. Sign the printed page and return to the Sports and Recreation office C-128. * I give permission to the Sports & Recreation Department to use the information contained in the Player Profile Sheet and pictures for 1) RSEQ league requirements, 2) press releases & the department Internet site, 3) recruiting purposes. * I certify that all information contained in this form is complete and accurate. I give my permission for the transmittal of the results of any medical evaluation and subsequent medical information to the Therapy Staff, Head Coach and Sports and Recreation Department at John Abbott College. I understand that I have to inform the Therapy Staff at John Abbott College of any change in my medical status while I am participating in a varsity sport at John Abbott College. * I agree to be bound by the terms and conditions as outlined in the Student-Athlete Obligations Contract. As you are participating in a Division 1 and/or contact sport, you are required to print out the following form and have it signed by a physician. Medical Form - Returning Players As you are participating in a Division 1 and/or contact sport, you are required to print out the following form and have it signed by a physician. Medical Form - Recruits ____________________________________ _________________ Name (please print) Sport ____________________________________ _________________ Signature Date (D/M/Y) ____________________________________ _________________ Parent or Guardian Signature* Date (D/M/Y) * Athletes under 18 years of age must have a parent or guardian sign this document.