SPMS Intramurals Permission Form 2021-2022
Email *
Player Name *
Player Grade *
Parent Name *
Parent Phone *
Parent Email *
Emergency Contact Name *
Emergency Contact Phone *
AWARENESS OF RISK
Parent Acknowledgement *
Your typed name below serves as your signature acknowledging that you have read and understand the above warning statement.
Student Acknowledgement *
Your typed name below serves as your signature acknowledging that you have read and understand the above warning statement.
CONSENT
I, the undersigned, being the parent or legal guardian of above named student, do hereby give my consent for the above named child to participate in the after school intramural program. The program will take place on specified dates throughout the school year on Tuesdays and Thursdays after school, from 2:45 – 4:00 pm. I know of no medical condition that the above named child has that would preclude him/her from participating in this program. I assume responsibility for ensuring my student gets home after practice ends at 4:00pm. I understand that practices may be cancelled on short notice due to inclement weather, high temperatures, or other reasons.
Parent or Legal Guardian Signature *
Your typed name below serves as your signature acknowledging that you have read and understand the above statement of consent.
Date Signed
MM
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DD
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YYYY
A copy of your responses will be emailed to the address you provided.
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