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SKYVIEW ACTIVITY/CLUB WAIVER
PLEASE READ BEFORE FILLING OUT THE FORM: By filling out this form, I give my consent for emergency medical and surgical treatment in a licensed medical facility by a licensed physician should my child's condition require it in my absence, I understand that in such a case, reasonable attempts would first be made to contact me, time, and conditions permitting. SkyView Academy does not have any medical/dental/hospitalization insurance covering students for injuries incurred at school, including before/after school activities. If you have not already done so you should investigate and must weobtain medical insurance coverage for your child. Any finances incurred are the parent's responsibly. As long as the medical or surgical treatment considered necessary in the situation is in accordance with generally accepted standards of medical practice for the particular type of injury or illness involved, I impose no specific prohibitions regarding treatment unless stated below.

I confirm to SkyView Academy that my child is in good health and that his/her participation does not pose a hazard to his/her health or that of participating students. I acknowledge that SkyView Academy does not have a health care professional on site. In the event of a medical emergency, 911 will be called to provide treatment and transport, if necessary. By filling out this form, I release and waive any and all claims which I now have or may hereafter have against SkyView Academy, its employees and affiliates pertaining to any injuries and/or medical emergencies that may occur while my child is participating in a before or after school activity.
Email address *
Name of Club *
Your answer
Student's Last Name *
Your answer
Student's First Name *
Your answer
Untitled Title
Student's Gender *
Date of Birth *
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DD
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YYYY
Student's Grade *
Your answer
Parent/Guardian Last Name *
Your answer
Parent/Guardian First Name *
Your answer
Parent/Guardian Cell Phone *
Your answer
Emergency Contact Name *
Your answer
Emergency Contact Cell Phone *
Your answer
Pediatrician Name and Number *
Your answer
List prohibitions regarding medical treatment
Your answer
List student's medical conditions which may require emergency care (including allergies)
Your answer
List medication(s) that your student will bring to this club including emergency medication(s) such as inhailer/epinephrine. This includes over the counter medication(s)
My student has a 504
By typing my name, I agree to the conditions listed above *
Your answer
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