Acknowledgement of Risk and Insurance Statement
Athletic Trip Permit
Athlete’s Name _________________________________
Address _______________________________________ Date of
Birth _______ Grade at
time of exam ____
Parent/Guardian’s Name ___________________________=
____
Daytime Phone Number ____________
Parent(s) Email Address ________________________________=
______________________________
Emergency Contacts Other Than Parents
=
Name &=
nbsp; &nbs=
p; &=
nbsp; Relationship
to Athlete =
; Phone
Number
1.
2.
I give permission for the above named athlete to participate in the above named sport. I have reviewed the individual eligibility rules and I am aware that with the participation in sports comes the risk of injury to my child/ward. I understand that= the degree of danger and the seriousness of the risk vary significantly from one sport to another with contact sports carrying the higher risk. I have had an opportunity to under= stand the risk inherent in sports through meetings, written handouts, or some oth= er means.
=
►Sign=
ature
of Parent or Guardian ______________________________ Date
_______________
Name of Insurance Company _______________________________
Policy Number __________
Name of Policy Holder __________________________________=
___
I am aware that participating in sports will involve tra=
vel
with the team. I acknowledge =
and
accept the risks inherent in the sport and with the travel involved and with
this knowledge in mind, grant unrestricted permission and consent to go on
athletic trips endorsed by
If the student has purchased school accident insuran= ce for the current year, it is in effect during school sponsored activities; howev= er, responsibility for passengers in a privately owned vehicle rests solely with the owner and driver of such vehicle and school authorities accept no respo= nsibility whatsoever. Such activities w= ould include; practice and home matches for the golf, tennis, swimming, softball, Cheerleading, football, wrestling, cross country, soccer, basketball, volleyball, lacrosse and track/field teams
=
►Sign=
ature
of Parent or Guardian _____________________________ Date
________________
&nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp;