HAC Athletics Medical and Recertification

Medical and Recertification

Participation Guidelines

In order for a student-athlete to be cleared to participate in any HAC interscholastic athletic program, the following items must be completed and turned in to either Allendale Columbia or The Harley School health offices.

1. A current Health Appraisal form dated no earlier than one year prior to the first of the month that the Varsity/J.V./Modified sport begins. A non-parent physician/nurse practitioner/physician’s assistant must complete the Health Appraisal form. This form must be on file in the health office.

2. Prior to the start of each sports season, both parent and student athlete must complete an Athletic Sports Recertification together. This form must be completed, signed and dated no earlier than 1 month prior to the start of the sports season.

There are 2 different forms for each school, please fill out the proper form according to the school they attend.

Allendale Columbia School families please complete the following:

Harley School families please complete the following:

3. Student athletes taking medication: Since teams sometimes have practices and/or competitions in the evenings and on weekends, all athletes must complete a “Permission to Administer Medication” form for each prescription and/or over-the-counter medication that they take except for those medications taken first thing in the morning or at night. Each individual medication requires a separate form with the student’s physician’s signature. This is required in order to meet NYS Education guidelines.

4. Student-athletes with diabetes mellitus, a history of a serious allergic reaction/anaphylaxis, or a seizure disorder, must have an “Emergency Care Plan” (ECP) completed by their physician in order to be cleared for practice. If an ECP is completed, a ”Permission to Administer Medication” form is not needed for medication referenced on the ECP.

5. Click this link to view the NYSPHSAA Student and Parent Information Sheet with regards to concussions.


Concussion Management Model

The Athletics Department of Harley Allendale Columbia (HAC) recognizes that concussions and head injuries are commonly reported in students-athletes who participate in sports and recreational activities.  The health of our student-athletes is our number one concern. In order to understand the policy and guidelines the below includes a definition of a concussion, staff training, information to parents, and return to play protocol.  Therefore HAC adopts the following policy described below in accordance to The Board of Education of the Brighton Central School District and the team physician.


A concussion is an injury at the cellular level of the brain causing biomechanical changes inside of the brain. This occurs from forces applied directly or indirectly to the skull that result in rapid acceleration and deceleration of the brain.  The sudden change in cerebral velocity elicits neuronal shearing, which produces changes in ionic balance and metabolism.

Staff Training:

Each coach is required to take HEADS UP, an online training course formed by Centers for Disease Control and Prevention (CDC).  This course is designed to allow coaches to understand the definition of a concussion, signs and symptoms, how to respond, steps to return to play, and the prevention process for a safe athletic environment.

Information to Parents: 

Signs & Symptoms of a Concussion:

  • Headache
  • Dizziness
  • Nausea
  • Neck pain
  • Sensitivity to light
  • Sensitivity to noise
  • Blurred vision
  • Slurred speech
  • Loss of Consciousness (LOC)
  • Mood swings (behavioral changes)
  • Sleep disturbance (cognitive impairment)
  • Depending on the severity of symptoms this will determine your son or daughters return to play progression.
  • The ImPACT Test (Immediate Post-Concussion Assessment and Cognitive Test) is a neurocognitive test that is administered by either the Athletic Trainer or Athletic Director. This test is given to every student-athlete before participation of the sport.  The test is re-administered every two years.  This test allows for baseline neurocognitive scores to be used as a pinpoint reference when a student-athlete sustains a concussion.  The test will compare baseline scores to post-concussion scores.

Return to Play Protocol:

  • Once a student-athlete has symptoms of a concussion the coaching staff will refer them to the Athletic Trainer. Athletic Trainers are highly qualified health care professionals who collaborate with physicians to provide prevention services, emergency care, therapeutic intervention and rehabilitation of injuries and medical conditions (NATA, 2016).
  • The Athletic Trainer will manage symptoms during that time and notify the legal guardians, athletic department and nursing staff of HAC. Once the legal guardians are notified they will be in contact with the Athletic Trainer for further questions and recommendations.
  • An Athletic Trainer is not allowed to diagnose a student-athlete with a concussion but if signs and symptoms persist as a concussion they will be referred to a physician concussion specialist. The legal guardian can take the student-athlete to their Primary Care Physician (PCP) if preferred.
  • Once a student-athlete is diagnosed with a concussion from the specialist or PCP they will be removed from athletic activity. *If symptoms affect classroom activity then the student will be in accordance with the Return To Learn progression created by HAC*
  • The student-athlete must have a clearance form signed by the licensed physician that diagnosed the concussion. This form must be handed to the Athletic Trainer to start the Return to Play Protocol.  Along with this form the student-athlete must be 24-hour symptom free before starting the Return to Play Protocol.  ImPACT test will be re-administered during this process to ensure that scores are back to baseline assessment.
  • Return to Play Protocol is a 6-day progression as followed:
  1. Light exertion
  2. Medium exertion
  3. Sports-specific exercises
  4. Non-contact training drills
  5. Contact-training drills
  6. Full practice
  • Once the 6-day progression is completed the student-athlete is cleared for full activity. Each progression will be customized to the current sport the student-athlete is participating in.  This will be created by the Athletic Trainer and supervised by either the Athletic Trainer or coaching staff.

In accordance with the NYSED guidelines and the team physician, this policy shall be reviewed periodically and updated as necessary.  For furthermore questions in regards to concussions or HAC policies please contact the information below:

Peter Mancuso

Director of Athletics, Harley School


Michael Taillie

Director of Athletics, Allendale Columbia School