HANDBOOK AGREEMENT/PERMISSIOM
PLEASE FILL OUT, SIGN, AND RETURN (Signatures required on both sides of this form!)
JHCA-E-2
HANDBOOK AGREEMENT
I, _________________________, understand and agree to abide by the rules in the Athletic (Student-Athlete Name) Handbook.
x________________________________
x
__________________________________ Student Signature Date Parent Signature Date ************************************************************************************* JAFFREY-RINDGE COOPERATIVE SCHOOL DISTRICT INTERSCHOLASTIC SPORTS In order to participate in interscholastic sports, students must have this form on file at school, completed and signed by the parent or guardian. To participate in sports, a complete physical is required EVERY YEAR. The attached physical examination form must be completed and signed by the physician and returned to the Health Office. In addition, the parent or guardian must certify that the student is covered by some form of medical insurance. The school does not provide medical insurance. However, parents may purchase a minimal coverage policy through the school. *****************************************************************
x__________________________________ has my permission to participate in the following sports this (Student-Athlete Name ) this school year:
( ) Any school approved sport ( ) Specific sport only ______________
I certify that medical insurance has been provided.
x Parent Signature:
________________________________ Date: ____________
IMPORTANT INFORMATION TO THOSE WHO WASH THE ATHLETE’S UNIFORM The average life-span of a uniform is 4-6 years. A manufacturer recently informed the school that this life-span can be doubled if the uniforms are turned inside out before washing. The Athletic Department, as well as the taxpayers, would greatly appreciate it if you would please wash all uniforms in this manner. Thanks in advance.
x Signature: _______________________________________
SCHOOL BOARD OF SAU #47 JAFFREY-RINDGE COOPERATIVE SCHOOL DISTRICT NOTIFICATION OF RISK WARNING, AGREEMENT TO OBEY INSTRUCTIONS, RELEASE, ASSUMPTION OF RISK, AND AGREEMENT TO HOLD HARMLESS NOTE:
The athlete and a parent or guardian must sign this form before any athlete may participate in interscholastic sports practices, games or meets.
SPORT: Athlete must circle sport(s) he/she will participate in during the current school year. Baseball Basketball Cross-Country
Field Hockey Golf Indoor Track
Outdoor Track Soccer Softball
Spirit Swimming Tennis
I am aware that playing or practicing to play/participate in any sport can be dangerous in nature involving MANY RISKS OF INJURY. I understand that the dangers and risks of playing or practicing to play/participate in the above sport(s) include, but are not limited to: death, serious neck and spinal injuries which may result in complete or partial paralysis, brain damage, serious injury or impairment to virtually all bones, joints, ligament, muscles, tendons, and other aspects of the muscular-skeletal system, serious injury to virtually all internal organs, and serious injury and impairment to other aspects of the body, general health and well-being. I understand that the dangers and risks of playing or practicing to play/participate in the above sport(s) may result not only in serious injury, but in a serious impairment of my future abilities to earn a living, to engage in other business, social and recreational activities, and generally to enjoy life. Because of the dangers in participating in the above sport(s), I recognize the importance of following coaches' instructions regarding playing techniques, training and other team rules, etc., and agree to obey such instructions. In consideration of the School Board of SAU #47, the Jaffrey-Rindge Cooperative School District, New Hampshire, permitting me to try out for the Conant High School team(s) circled and to engage in all activities related to this team, including, but not limited to, trying out, practicing or playing/participating in that sport, I assume all risks associated with participating and agree to hold the School Board of SAU #47, the Jaffrey Rindge Cooperative School District, New Hampshire, its employees agents, representatives, coaches, and volunteers harmless from any and all liability, actions, causes of actions, debts, claims, or demands of any kind whatsoever which may arise by or in connection with my participation in any activities related to the Conant High School sports that have been circled. The terms hereof shall serve as a release and assumption of risk for my heirs, estate, executor, administrator, assignees, and for all members of my family. ________________________________________ ATHLETE'S NAME (PRINT)
x________________________________________ SIGNATURE OF ATHLETE
________________________________________ DATE
____________________________________ PARENT/GUARDIAN NAME (PRINT)
x____________________________________ SIGNATURE OF PARENT/GUARDIAN