Athletic Permission Form

                                                     (Only one form per student per school year is required.)

 

 

Student=s Legal Name_____________________________________________Grade______Date of Birth_____________

 

 

1.             I hereby give consent to the above named student to participate in any of the following sports:

BOYS: Soccer, basketball, wrestling, baseball, track & field.

GIRLS: Volleyball, cheerleader, basketball, track & field.

2.             I agree to allow my child to travel with the school teams at my own risk

3.             I realize that the primary insurance coverage, if an injury should occur, would be my responsibility.

4.             I am aware that physical examinations are the parents= responsibility to schedule in order to clear the student for athletic participation.  Evidence of the physical examination (recorded below) must be given to the coach before a student participates in any athletic event.

5.             I hereby give consent for my child to receive aspirin, Tylenol or ibuprofen if needed.          

 

 

Parent of Guardian Signature_____________________________________________________________Date____________________

 

In case of emergency:

Home phone____________________Father=s Work Phone____________________Mother=s Work Phone____________________

Cell Phone   ____________________Relative____________________