GRANDVIEW MIDDLE SCHOOL ATHLETICS
Acknowledgement of Risk and Insurance Statement
Athletic Trip Permit
Athlete’s Name ______Sport(s) ______
Address ______Date of Birth ______Grade at time of exam ____
City______State _____ Zip ______Home Phone Number ______
Parent/Guardian’s Name ______Daytime Phone Number ______
Parent(s) Email Address ______
Emergency Contacts Other Than Parents
NameRelationship to AthletePhone Number
1.
2.
ACKNOWLEDGEMENT OF RISK
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 understand the risk inherent in sports through meetings, written handouts, or some other means.
►Signature of Parent or Guardian ______Date ______
INSURANCE INFORMATION
Name of Insurance Company ______Policy Number ______
Name of Policy Holder ______
ATHLETIC TRIP PERMIT
I am aware that participating in sports will involve travel 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 GrandviewMiddle School.
If the student has purchased school accident insurance for the current year, it is in effect during school sponsored activities; however, responsibility for passengers in a privately owned vehicle rests solely with the owner and driver of such vehicle and school authorities accept no responsibility whatsoever. Such activities would include; practice and home matches for the golf, tennis, swimming, softball, Cheerleading, football, wrestling, cross country, soccer, basketball, volleyball, lacrosse and track/field teams
►Signature of Parent or Guardian ______Date ______