Nauset Regional High School

RELEASE OF ALL CLAIMS

Parental Permission for Cheerleading Tryouts

Date: ____ / _____ / ______

Name of Parent / Guardian: _______________________________

Address: _______________________________________________

Name of Student: _________________________________________

Date of Birth: _____ / _______ / ________

In consideration of permission granted the above-named student by the Nauset Regional School District, Orleans, MA to attend Cheerleading Tryouts sessions. I hereby release and discharge the above-named District, its agents, employees, and officers, from all claims, demands, actions, judgements and executions which I may have or which my heirs, executors, administrators, or assigns mat have, or claim to have against the above-named School District, its successors or assigns, for all personal injuries, known or unknown, and injuries to property, real or personal, caused by, or arising out of, the above described activity.

I further hereby authorize a representative of the school district to consent to medical treatment of the above-named student in the event of an emergency during the clinic.

I authorize the physicians, EMT’s and/or hospital deemed necessary to treat any injury or illness to my child’s most advantageous welfare.

I, the undersigned, have read this release and consent to medical treatment and understand all its terms. I execute it voluntarily and with full knowledge of its significance.

_____________________________________________ Date _____________________

(Signature of Parent or Guardian)

Insurance Provider: ______________________ Policy Number:___________________

In Case of Emergency: (List two people)

1. ____________________________ Phone:_______________________

2. ____________________________ Phone:_______________________