Acknowledgement Of Rules Form
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1
2ACKNOWLEDGEMENT OF RULES
Attention School Authorities: This form must be signed yearly by both the student and parent/guardian and be
on file at your school before the student may participate in any practice session, scrimmage, or contest. A copy
of the student’s medical history and physical examination form signed by a physician or medical history form
signed by a parent must also be on file at your school.
Student’s Name _______________________________________________Date of Birth ________________
Current School _______________________________________________
Parent or Guardian’s Permit
I hereby give my consent for the above student to compete in University Interscholastic League approved sports, and
travel with the coach or other representative of the school on any trips.
It is understood that even though protective equipment is worn by the athlete whenever needed, the possibility of an
accident still remains. Neither the University Interscholastic League nor the high school assumes any responsibility in
case an accident occurs.
I have read and understand the University Interscholastic League rules on the reverse side of this form and agree that my
son/daughter will abide by all of the University Interscholastic League rules.
The undersigned agrees to be responsible for the safe return of all athletic equipment issued by the school to the above
named student.
If, in the judgement of any representatives of the school, the above student needs immediate care and treatment as a
result of any injury or sickness, I do hereby request, authorize, and consent to such care and treatment as may be given
to said student by any physician, licensed athletic trainer, nurse, hospital, or school representative; and I do hereby agree
to indemnify and save harmless the school and any school representative from any claim by any person whomsoever on
account of such care and treatment of said student.
I have been provided the UIL Parent Information Manual regarding health and safety issues including concussions and my
responsibilities as a parent/guardian. I understand that failure to provide accurate and truthful information on UIL forms
could subject the student in question to penalties determined by the UIL.
The UIL Parent Information Manual is located at
Your signature below gives authorization that is necessary for the school district, its licensed athletic trainers, coaches,
associated physicians andstudent insurance personnel to share information concerning medical diagnosis and treatment for
your student.
To the Parent: Check any activity in which this student is allowed to participate.
Baseball
Football
Softball
Tennis
Basketball
Golf
Swimming & Diving
Track & Field
Cross Country
Soccer
Team Tennis
Volleyball
Wrestling
Date_________________
Signature of parent or guardian__________________________________
Street address________________________________________________
City________________________ State _______________ Zip ______________
Home Phone ________________________ Business Phone ________________________
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