By signing below, I am electing an ECG screen provided by Rockledge High School for my child. By electing to receive an ECG screen, I acknowledge the limitations of an ECG screen and that sudden cardiac death or other cardiac events may still occur, despite this screening. I further acknowledge that students with an abnormal ECG screen will be required to undergo further testing (e.g. an echo or ultrasound) and/or a medical consultation prior to being released to resume participation in Rockledge High School athletics. By my signature below, I hereby release and forever discharge, and waive, any and all claims against Rockledge High School for, its employees, sponsors, trustees, consultants, volunteers and contractors that relate to my election regarding and/or my child’s participation in this ECG screening project. I authorize medical personnel to review the ECG results, and interpret and use the same for diagnostic and aggregated statistical purposes in accordance with the Family Education Rights and Privacy Act and Health Insurance Portability and Accountability Act of 1996.