ATHLETIC
PARTICIPATION
PERMISSION FORM
Student Name_______________________Birthdate_____________
Parent Name________________________Home
Phone__________
Day Phone______________ Student
Grade______________
Please
answer the following questions pertaining to athletic eligibility and fill out
all other information on this form. It
is extremely important to give accurate information. A participant/parent/guardian who provides the school with false information may cause the
participant to be declared ineligible for interscholastic competition for a
period of one year.
___Yes
___No The
student is under 20 years of age.
___Yes
___No The
above student resides within the boundaries of the Grand
___Yes
___No The
above student resides with their parents/legal guardians.
___Yes
___No The Student was in attendance
in school at least 15 weeks of the
previous semester.
___Yes
___No The
student met academic eligibility standards during the quarter/
semester.
___Yes
___No The
student is presently enrolled in the
District.
___Yes
___No The
above student is in running start.
___Yes
___No The
above student is a registered home school student.
School
Attended Last Year______________________________________________
From
(month/year) ____/____to ____/____
Athletic
Director Approval
_______________________________________Date_________________________
Parental Assumption of Responsibility
For Students on School Sponsored Extra Curricular
Trips
As parent/legal guardian of
the student listed on this form my signature at the end of this form gives
permission for the above named student to be dropped off at one of the
district-designated bus stops after out-of-town extra curricular
activities. I understand it is my
responsibility to see that my child is picked up at the designated stop or at
school. I further understand that there
will not be school provided supervision at any of the designated stops unless
it is the final destination.
REQUEST FOR WAIVER OF ACCIDENT PLAN COVERAGE
Dear Principal,
I
understand that my child cannot participate in interscholastic activities
unless my child is covered by the School Accident Coverage Plan or by a plan
provided by the family.
_____I
have insurance coverage the equivalent or better than the Washington State
Industrial Insurance Fee Schedule for doctor’s services and hospitalization and
will keep it in force throughout the sport; therefore, I do not wish to enroll
my child named on this form in the School Accident Coverage Plan.
The
name of my insurance company providing coverage is:
____________________________________________________________________
_____I accept full
responsibility for the cost of treatment for any injury which my child may
suffer while taking part in the program.
Please waive this requirement and permit my child to take part in
athletics and Spot Days.
My initials here, and my signature at the end of this form indicate I
understand this provision and agree to this waiver.
Parents Initials__________
STUDENT PARENT/GUARDIAN WARNING & ASSUMPTION OF
RISK
It
is the school district’s intent to provide any athlete with good instruction,
safe equipment, and safe transportation; but we cannot eliminate all risks
involved in sports participation. ACCIDENTAL
INJURY, COMPLETELY UNRELATED TO ANY PREVENTABLE CAUSE, IS ALWAYS POSSIBLE.
This
ASSUMPTION OF RISK form is designed to provide this school district with
a degree of protection. It is not
designed to deny the rights of an injured athlete. OUR
“WARNING”
Participation
in any athletic activity may involve injury of some type to either yourself or
a fellow student athlete. Such injury
can include direct physical and possibly crippling injury to one’s body and the
possibility of emotional injury experienced as a result of witnessing o
actually inflicting injury to another.
The severity of such injury can range from minor to catastrophic injury
such as complete paralysis or even one’s future ability to earn a living, engage
in business, social, and recreational activities, and generally enjoy life.
Activity
injuries can result from the incorrect performance of playing techniques used
in tryout, practices, warm-ups, games, drills, exercises, and other similar
undertakings. Injury can also result
from failing to follow game, training, safety, or other team rules. Injury can result from the use of
transportation provided or arranged by the school district to and from
interscholastic activity. Therefore, the
purpose of this WARNING is to aid you in making an informed decision as
to whether you/your child or ward should participate in these activities. In addition, it’s purpose is to make you
aware that as a student participant, parent/guardian of student participant, it
is your responsibility to learn about and/or inquire of coaches, physicians,
advisor or other knowledgeable persons about concerns that you might have at
any time regarding participant’ safety.
In
consideration of the
By
signing at the end of this form, we acknowledge that we have read and
understand the content of this WARNING of risk in athletics and we agree
to allow the student named on this form to participate in interscholastic
activities.
Parents
Initials__________ Student Athletes
Initials______________
PARTICIPATION GUIDELINES FOR ATHLETICS
As
a student athlete I have read and understand the Grand Coulee Dam School
District Athletic Code. Furthermore, I agree to abide by its conditions.
Student
Athlete Signature____________________________
Date______________.
I
the parent/guardian have read and understand the Grand Coulee Dam School
District Athletic Code. My signature indicates my permission for the student
named on this form to participate in all sports during the ______________
school year. Furthermore, my signature
indicates I understand and will abide by the conditions outlined in this form
Parent/Guardian
Signature___________________________
Date_________________