OPTIONAL PARTICIPATION IN INTERSCHOLASTIC

ATHLETICS AND AFTER SCHOOL ACTIVITIES

Consent Form

My child, ______________________________, has my permission to participate in the following interscholastic sports or activity.  (Please check only one activity each season) 

Note: Student’s requests for changes should be submitted in writing to the Athletic Director. 

I was offered the opportunity to participate in the student accident insurance program as part of contracted enrollment/reenrollment.  I understand that this program is optional and limited to the coverage specified in the brochure.  I realize that there is a possibility that my child may suffer injury, even serious injury or death as a result of participation in athletics. 

I further understand that St. James Academy and St. James Episcopal Church disclaims any financial responsibility for the costs of medical treatment, hospitals, ambulances, or paramedics, etc., arising out of or by virtue of an injury to my child while participating in such interscholastic competition or preparation thereof. 

Before my child may participate in school-sponsored sport(s), this consent form must be executed by me and filed at the school.  By signature below, I declare that my child is physically fit to participate in such school-sponsored activities. 

Date of Signature     ________________         Print Name of Parent/Guardian   _________________________________

Telephone Number  ________________         Signature of Parent/Guardian    _________________________________