Student Sports & Games Permission Form

STUDENT SPORTS & GAMES PERMISSION FORM

Student Information

Date of Birth:

Parent / Guardian Information (If student is a minor)

Emergency Contact

Medical Information & Authorization

Does the student have any allergies, chronic medical conditions, or special needs that staff should know? Please describe.

Consent for administration of routine over-the-counter medication (e.g., acetaminophen, ibuprofen, topical ointment): I consent I do not consent

Activity Details

Activities and Games for which permission is granted (check all that apply):

Soccer    Basketball    Track & Field    Swimming    Baseball/Softball    Cheer    Other:

Event Date(s):

Transportation

I authorize transportation of the student for the above activities as indicated below (check all that apply):

School bus or contracted bus    Staff/volunteer private vehicle    Parent/guardian pickup

If transported by staff or volunteer private vehicle, emergency contact for driver (if known):

Assumption of Risk, Release & Indemnity

I acknowledge that participation in sports and game activities involves the risk of physical injury, illness, and, in rare cases, death. I knowingly and voluntarily assume all risk associated with the student's participation and agree that the school, its employees, volunteers, coaches, agents, and representatives shall not be liable for injury, loss, or damage resulting therefrom except where caused by the institution's gross negligence or willful misconduct.

To the fullest extent permitted by law, I release, waive, and discharge the school, its agents, employees, volunteers, and sponsoring organizations from any and all claims, demands, actions, or causes of action arising from or related to the student's participation, and I agree to indemnify and hold harmless the released parties from any liabilities, costs, or expenses (including reasonable attorney fees) arising out of the student's actions or omissions while participating in the activities.

Emergency Medical Treatment Authorization

In the event of an emergency where immediate medical treatment is necessary and I cannot be reached, I authorize the school or its designee to obtain medical care for the student and to consent to such care, including transportation to an emergency medical facility. I understand that reasonable efforts will be made to contact the parent/guardian or emergency contact prior to the administration of non-emergency treatment.

I understand that the student is responsible for personal health insurance coverage and that the school may not carry medical insurance for participants. I agree to be financially responsible for any medical expenses incurred on behalf of the student that are not covered by insurance.

Photo / Video Release

I grant permission for the student's image, voice, or likeness to be photographed, videotaped, or otherwise recorded during sanctioned activities and used by the school for educational, promotional, or archival purposes, subject to applicable privacy policies.

I consent to use of the student's likeness    I do not consent to use of the student's likeness

Behavior & Policy Acknowledgment

I acknowledge that the student must comply with all applicable rules, codes of conduct, and direction of coaches, staff, and officials. The school reserves the right to remove the student from participation for behavioral or safety reasons. Suspension, dismissal, or other disciplinary measures may result from failure to comply.

I acknowledge and agree that the student will follow all rules and directives of staff and coaches

Certification and Signature

By signing below I certify that I am the parent or legal guardian of the student named above (or the student if age eighteen or older). I have read this form in its entirety, understand its terms, and agree to its provisions. I confirm that the information provided on this form is true and complete to the best of my knowledge.

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