PENNSYLVANIA ACADEMIC DECATHLON 2018
STUDENT REGISTRATION AND PARENT PERMISSION FORM
STUDENT’S NAME: ______
HIGH SCHOOL: ______GRADE:
HOME ADDRESS:
City State Zip
TELEPHONE (parent): ______
I hereby request permission to participate in the Pennsylvania Academic Decathlon Western Regional Competition scheduled for February 9-10, 2018 at Northwestern High School (200 Harthan Way • Albion, PA).
My parent(s) or guardian, my coach and I, whose signatures appear below, hereby agree to follow the competition rules and to accept the interpretations and decisions made by the state director. I/We also agree to assume the risks involved in the use of Northwestern High School (Northwestern School District) facilities and equipment for this event. I have read and agree to adhere to the USAD Code of Conduct (on reverse). I agree to adhere to the highest standards of honesty and integrity while participating in Pennsylvania Academic Decathlon competition.
My parent(s) or guardian and I hereby release from all liability and responsibility the Pennsylvania Academic Decathlon, its’ board, Northwestern Intermediate High School, and the Northwestern School District including its officers, trustees, employees, and representatives, and hold each of them harmless from any damage or injury which may be incurred or caused by me before, during or following any such competition, including travel. We further consent to the release of information about or relative to my participation in competition activities, including scores, photographs, sound and video recordings and any other data. The Pennsylvania Academic Decathlon shall have full rights to reproduction and use of all such materials.
I/We understand that the team coach is the official chaperone and that (s)he has full responsibility to make medical or other necessary decisions and that my parent(s) and I will be held responsible for any damages resulting from my behavior. I also authorize that my transcript and any other pertinent materials may be sent to the PAAD Office for verification of my eligibility to participate in the competition.
I/We affirm that I/we are freely signing this agreement and have read and fully understand its content. I/We understand that this is a binding legal document.
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Student’s Signature Date
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Parent’s/Guardian’s Signature Date
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Coach’s Signature Date
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School Administrator’s Signature and Title Date
Mail the original of this permission form to Michelle Schroeder by January 19, 2018.