Sport_________________________                                                                      Student Name________________________             

 

STURGIS CHARTER PUBLIC SCHOOL

 

Department of Athletics

 

Directions:

Please complete this form and return it to the Athletic Department or coach no later than the first day of practice. Completed forms may be faxed to 508-771-6785.

 

Participation in athletics is inherently dangerous. Even when all reasonable precautions are taken, students can be, and indeed, may be injured. All students participate in athletics voluntarily with permission of their parents or guardians. Along with this participation, the students and their parents/guardians accept the inherent risks to which the students expose themselves to.   

 

I HAVE READ AND I UNDERSTAND THE ABOVE CONCERNING PARTICIPATION IN INTERSCHOLASTIC ATHLETICS FOR STURGIS CHARTER PUBLIC SCHOOL.

 

________________________________             ________________________________

                 student signature                                          parent/guardian signature 

 

____________________________________

Date

 

 

Emergency Contact Info (Please list at least two people)

 

Contact 1 (parent or guardian)

 

Name_____________________________Relationship________________________

 

Cell Phone__________________________ Work Phone_______________________

 

Home Phone_________________________________________

 

Contact 2 (emergency contact)

 

Name_____________________________Relationship_________________________

 

Cell Phone__________________________ Work Phone_______________________

 

Home Phone_________________________________________