NSAA Student and Parent Consent Form
To be completed for students participating in any NSAA Activities in the 2022-23 school year at Rock County Public Schools.
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Name of Student: *
Student's Date of Birth: *
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Student's Place of Birth: *
The undersigned(s) are the student and parent(s), guardian(s), or person(s) in charge of the above named Student and are collectively referred to as "Parent"
The Parent and Student hereby:

(1) Understand and agree that participation in NSAA sponsored activities is voluntary on the part of the Student and is a privilege;

(2) Understand and agree that (a) by this Consent Form the NSAA has provided to the Parent and Student for the existence of potential dangers associated with athletic participation; (b) participation in any athletic activity may involve injury of some type; (c) the severity of such injury can range from minor cuts, bruises, sprains, and muscle strains to more serious life injuries to the body's bones, joints, ligaments, tendons, or muscles, to catastrophic injuries to the head, neck and spinal cord, and on rare occasions, injuries so severe as to result in total disability, paralysis and death; and , (d) even in the best coaching, the use of the best protective equipment and strict observance of rules, injuries are still a possibility;

(3) Consent and agree to participation of the Student in NSAA activities subject to all NSAA by-laws and rules interpretations for participation in NSAA sponsored activities, and the activities rules of the NSAA member school for which the Student is participating; and,

(4) Consent and agree to (a) the disclosure by the Member School at which the Student is enrolled to the NSAA, and subsequent disclosure by the NSAA, of information regarding to the Student, including the student's name, address, telephone listing, electronic mail address, photograph, date and place of birth, major fields of study, dates of attendance, grade level, enrollment status (e.g., full-time or part-time), participation in officially recognized activities and sports, weight and height as a member of athletic teams, degrees, honors and awards received, statistics regarding performance, records or documentation related to eligibility for NSAA sponsored activities, medical records, and any other information related to the Student's participation in NSAA sponsored activities; and, (b) the Student being photographed, video recorded, audio taped, or recorded by any other means while participating in NSAA activities and contests, consent to and waive any privacy rights with regard to the display of such recordings, and waive any claims of ownership or other rights with regard to such photographs or recordings or to the broadcast, sale or display of such photographs or recordings.

(5) Consent and agree to authorize licensed sports injury personnel to evaluate and treat any injury or illness that occurs during the student's participation in NSAA activities.  This includes all reasonable and necessary preventative care, treatment and rehabilitation for these injuries.  This would also include the transportation of the student to a medical facility if necessary.  Such .licensed sports injury personnel are independent providers and are not employed by the NSAA.

(6) Acknowledge that Parents are obligated to pay for professional medical and/or related services; the NSAA shall not be li9able for payment of such services.  We give permission to any and all of the Student's health care providers and the NSAA and it's employees, staff, agents, and consultants to release and discuss all records and information about the Student including otherwise confidential medical information and records.  We understand that this release has been requested and may be used for the purpose of determining eligibility pertaining to activities, participation, fitness, injury, injury status, or emergency.

I acknowledge that I have read paragraphs (1) through (6) above, understand and agree to the terms thereof, including the warning of potential risk of injury inherent in participation in athletic activities.
Electronic Signature of Student: *
Date: *
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(I am) (We are) the Student's Parent/Guardian.  (I)(We) acknowledge that (I) (We) have read paragraphs (1) through (6) above, understand and agree to the terms thereof, including the warning of potential risk of injury inherent in participation in athletic activities.  Having read the warning in paragraph (2) above and understanding the potential risk of injury to my Student, (I)(we) hereby give (my)(our) permission for my child (listed above) to practice and compete for the above named high school in activities approved by the NSAA, EXCEPT those marked below.
ONLY mark the activities that you DO NOT wish to allow your Student to participate in:
Electronic Signature of Parent/Guardian: *
Date: *
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