Parent/guardian authorization for afterschool programs SY22-23 (Basketball)

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Competitive Basketball for grades 6-8. With any questions, please contact Athletic Director Tanasha Allen at
tallen@meridian-dc.org

Pre-season ractices are held on Monday, Tuesday & Thursday

Girls: 4:00 - 5:30

Boys: 4:00 - 5:30

During Season Practices are Tuesday & Thursday

Games on Monday and Fridays from 4:00 - 6:00 PM

Amiri Allen, Coach Boys
Basketball aallen@meridian-dc.org

Briana Wojcik, Coach Girls
Basketball bwojcik@meridian-dc.org

Trevor Proctor, Assistant Coach (Both Teams)

Basketball tproctor@meridian-dc.org

Email *

Student's name: *

Student's Grade *

Student's homeroom teacher: *

Parent/ Guardian Authorization and Acknowledgement of Risk

I, as the parent or legal guardian, give permission for the student named above to participate in this afterschool program. I have read and understand the purpose of the program. I understand that participation in clubs and sports teams is open to students in eligible grades with a 2.5 or higher GPA; students with less than a 2.5 GPA may be suspended from participating in afterschool programs without additional notice. I understand that if my student is invited to participate in intervention tutoring at any point during the school year, my student’s regular participation in intervention tutoring takes priority, superseding participation in any after school club or sport. Should participation in the after school program involve activities off of the school premises, neither Meridian nor its employees and volunteers have any responsibility for the condition or use of any non-school property. *

I acknowledge and give my permission

I do not give my permission

Medical Authorization

I understand the school nurse’s hours of operation are 8:00 AM – 4:30 PM. The school has my permission, when I (or my student’s physician) cannot be contacted, to take my child to the emergency room of the nearest hospital (in a private automobile or emergency vehicle). I further provide the hospital and its medical staff my authorization to provide treatment, which a physician deems necessary for the well-being of my child.
*

I agree to the medical authorization above

I do not agree for my student to participate in this after school program

Notice of Cancellation

Please note that the school and/or afterschool sponsor reserves the right to cancel any meeting after school program when needed. If a club meeting is cancelled, your student must be picked up on time, at the school’s normal dismissal time. I understand that the school will notify me and/or other authorized persons as soon as possible by phone, text message, email, or Remind about the cancellation of the day’s afterschool program(s). By checking the box and signing below, parents/guardians acknowledge that they have read this notice and accept responsibility for any late pick-ups.
*

I agree to the notice of cancellation above

I do not agree for my student to participate in this after school program

When the afterschool program is over, the student will be: *

Picked up by Parent or other authorized person

Going to Metrobus/metrorail independently

Walking/biking independently

Other:

By typing your name below, you are signing this form electronically and acknowledging that your electronic signature is the legal equivalent of your manual signature.
*

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