Parent Permission for Participation
Please provide a parent/legal guardian email address on this form.
Email address *
Activity *
Student Code of Conduct

Dear Parent:

The junior high school athletic program of the Weber School District is again being conducted this year.

With the welfare of all concerned in mind, we are requesting that the procedures listed below be followed before your son/daughter will be eligible to participate in the athletic program.

Your digital signature will be interpreted to mean that you have complied with each one of the following items:

That you have given consent to having your son/daughter participate in the athletic program and to travel to and from other schools for this purpose.

That he/she has been examined by a physician licensed in the state of Utah and has been found physically acceptable to participate. A signed statement from the physician must be provided to the school. This must have taken place within a 12 month period prior to the sport in which the student is participating.

3. That you have given emergency medical authorization at your expense for transportation and/or treatment by a physician or hospital when the parents/guardian are not available.

That he/she is covered by insurance. (See question below)

That you are aware that there are eligibility requirements for participation and that your son/daughter will comply with and meet those requirements or will not be allowed to participate.

You further certify by digitally signing below that you agree that any claim or dispute arising out of injuries sustained while participating in these activities shall be settled by binding arbitration administered by the American Arbitration Association under its commercial arbitration rules, and judgment on the award rendered by the arbitrator(s) may be entered in any court having jurisdiction thereof.

Student First Name (Please capitalize the first letter with the rest lower case i.e. John) *
Your answer
Student Last Name (Please capitalize the first letter with the rest lower case i.e. Smith) *
Your answer
Parent/Legal Guardian First Name *
Your answer
Parent/Legal Guardian Last Name *
Your answer
The student named above is covered by insurance. Please check one of the following: *
A copy of your responses will be emailed to the address you provided.
Never submit passwords through Google Forms.
This form was created inside of Weber School District. Report Abuse - Terms of Service - Additional Terms