Athletic Permission And Hold Harmless Form printable pdf download

ATHLETIC PERMISSION AND HOLD HARMLESS

VOLUNTARY PARTICIPATION

(Name of Student) ___________________________________________has my permission to participate in the following voluntary

extra-curricular activities (athletics) sponsored by _______________________________________________________

Basketball

Volleyball

Tackle Football

Soccer

Swimming

Tennis

ACKNOWLEDGEMENT

I understand and acknowledge that participation in these activities is completely voluntary and as such is not required by the school

for course credit or for completion of graduation requirements. I also understand and acknowledge that my child must meet the

minimum student behavior and performance requirements of the _________________________________School District in order to

participate in practices, preparation and sporting events.

I also understand and acknowledge that participation in the above sport/s, by their very nature, pose the potential risk of serious

injury to individuals who participate in such activities including, but not limited to the following:

Sprains/strains

Head and/or back injuries

Fractured bones

Paralysis

Cuts/abrasions

Loss of eyesight

Unconsciousness

Death

HOLD HARMLESS AGREEMENT:

I UNDERSTAND, ACKNOWLEDGE AND AGREE TO HOLD HARMLESS THE ______________________________SCHOOL DISTRICT, ITS

BOARD OF TRUSTEES, OFFICERS, AGENTS AND EMPLOYEES INDIVIDUALLY AND COLLECTIVELY, FROM ANY AND ALL COSTS, LOSSES,

CLAIMS, DEMANDS, SUITS, ACTIONS, PAYMENTS AND JUDGMENTS, INCLUDING LEGAL AND ATTORNEY FEES, ARISING FROM

PERSONAL OR BODILY INJURIES, PROPERTY DAMAGE OR OTHERWISE, HOWEVER CAUSED, BROUGHT OR RECOVERED AGAINST ANY

OF THE ABOVE THAT MAY ARISE FOR ANY REASON FROM OR DURING OR BE ALLEGED TO BE CAUSED BY THE ABOVE STUDENT’S

PARTICIPATION IN THE ABOVE ATHLETIC EXTRA-CURRICULAR ATHLETIC ACTIVITIES

IMMUNITY: As provided for in California Education Code Section 35330, all persons making the field trip or excursion shall be

deemed to have waived all claims against the District for injury, accident, illness, or death occurring during or by reason of the field

trip or excursion; and all adults taking out-of-state field trips or excursions and all parents or guardians of pupils taking out-of-state

field trips or excursions shall sign a statement waiving such claims.

RELEASE: This provision shall not limit, to any extent, the immunity from liability afforded the District under California Education

Code Section 35330. I agree, on behalf of myself and my child whose name is set forth on this form, to release, discharge, hold

harmless and indemnify the District, its officers, employees and agents from all liability or claims, which may arise out of or in

connection with my child’s participation in this field trip or excursion.

MEDICAL TREATMENT:

Health or special needs: Check as appropriate and attach instructions if applicable.

trip.

My student has no special health needs the staff should be aware of, and no medication is required on the

My student has a special need, and instructions are attached. Number of attached pages: _________.

My student has the following allergies:

Other: ________________________________________________________________________

In the event of illness or injury, I do hereby consent to whatever x-ray exam, anesthetic, medical, surgical, or dental diagnosis or

treatment and hospital care are considered necessary for my child in the best judgment of the attending physician.

I acknowledge that I have carefully read this Athletic Permission/ Hold Harmless form and that I understand and agree to its terms.

________________________________________

__________________________________________

Parent/Legal Guardian Signature

Date

Athletic Permission And Hold Harmless Form

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