Kamiak HS Summer Athletic/Activities Parent Permission and Assumption of Risk Form 
Current Kamiak High School Students participating in summer athletic activities must complete this form prior to participation. Summer athletic activities may begin on June 2, 2025 and end on or before July 31, 2025.

Only current and incoming Kamiak students may participate with Kamiak High School Sports programs over the WIAA Spring/Summer Activity period. If you are not currently enrolled in Kamiak for the Fall of 2025 , then you cannot participate in Spring/Summer activities until you have officially enrolled in Kamiak through the Registrar's Office.  
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Student's First Name *
Student's Last Name *
Student School ID number *
Parent/Guardian First and Last Name:  *
Parent/Guardian Phone Number *
What is the current grade level of your student for the 2024-2025 school year *
Please list all summer activities that your student will participate in for Summer 2025.  *
Required
As a parent/guardian of a student requesting to participate in summer activities sponsored by the Mukilteo School District, I herby acknowledge that I have read, understood and agree to the following:  *
Required
Transportation: I understand that a district-approved Mukilteo School District program may provide transportation in some instances; however, transportation will not be provided in most instances.  Your signature below indicates your agreement to provide and arrange transportation for the summer activities your student will be participating in. 
 *
Insurance Coverage - I understand that I am assuming financial responsibility for medical expenses that may arise from my child’s participation and that the Mukilteo School District requires but does not provide medical insurance for my child.  I certify that my child has current medical coverage under the following plan: 

Please provide the Name and Policy number of the your student's Insurance Carrier. 
 *
Special health condition - *IF YOUR STUDENT HAS A HEALTH CONDITION:  Medical files, supplies and medications are locked in the health room after school, and coaches/advisors DO NOT have access to these. Please send a dedicated supply of any medications (inhalers, Epipens, etc.)  that your student might need to practice each day and make sure your student knows how to use them. Please inform staff of any life-threatening or chronic health conditions they should be aware of, in case of any emergency. 

The following Special health conditions should be noted: 
 *
Medical Release: In the event of an accident or illness, I understand that reasonable effort will be made to contact the parent/guardian immediately.  However, if I am not available, I authorize the Mukilteo School District to secure emergency medical care as needed.

Please list below the name and phone number of your preferred doctor. 
 *

Although I understand that the Mukilteo School District will make reasonable effort to provide a safe environment, I am fully aware of the special dangers and risks inherent in participating in this activity, including physical injury and/or death.  Being fully aware of the risks, I hereby give for my student to participate in the above listed summer activity/activities for the purpose of practicing fundamental skills to enhance individual skill and performance levels. 

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