Fill and Sign the Acknowledgement School Form

Athletic Risk Acknowledgement Statement for Parents or Guardians of Student in Middle School Dear Parent/Guardian: Athletics is an important part of a student’s middle school experience and we are glad you have chosen to participate in our athletic program. It is our duty to inform you that the potential for injury exists in any sport, practice and competition, and at all levels. These injuries may range from minor bruises and scrapes to disabling injuries such as severe ligament damage, brain damage, spinal cord paralysis and death. This notice is not meant to deter you from permitting your son/daughter to participate. Although severe injury in athletics is not common, injuries are inevitable and cannot be completely eliminated. There are certain preventative measures which can be taken, one of the most important is to maintain good general conditioning which prevents injury and decreases down time when an injury does occur. In general, athletes must follow all safety instructions, use correct technique and skills, use appropriate equipment that fits correctly, inspect equipment daily for proper working condition, wear appropriate shoes for the activity, report all injuries to the coach immediately, follow guidelines for return to play after injury, and receive a physical exam upon entering the middle school or following an injury of a serious nature. The following is a risk acknowledgement and consent to participate. Do not sign this form if you have any hesitations and are not willing to accept the risks described above. I understand that the risks involved in athletics range from minor to severe. I recognize the possibility that my child may die, become paralyzed, or suffer brain damage as a result of participation in this sports program. I realize that neither the protective equipment and padding used in the safety, rules or procedures of the sport, the coaching instruction received will guarantee safety or prevent injuries that my child may sustain. I agree to accept these risks as a condition of my child’s participation in this program. I further agree not to hold the ___________________________________ (Name) School District or its Coaches responsible for any injury, loss or damage that occurs to my child as a result of participating in Sports. Athletes Name__________________________________________ Grade__________ Athletes Signature_______________________________________ Date___________ Parent/Guardian Signature________________________________ Date___________ Sport ________________________________________________________________ Do not sign this form if you have questions or concerns!