General After School Program Registration - Waiver Form (Page 2 of 2) in pdf

Alhuda

248 East Mountain St. , Worcester MA 01606

Tel: 508- 854-4700

Fax: 508-854-4711

Academy

P.O. Box 4040 T/S, Shrewsbury, MA 01545

I understand that Massachusetts school regulations require that all students participating in interscholastic

or other voluntary after school athletics must have a physical examination within 12 months prior to the

sport season in which they are participating.

I/We, on behalf of myself and my minor child, agree to release, hold harmless and indemnifyAlhuda Academy,

their employees, officers and agents, from any loss, cost, damage and/or expense of any nature, including all

attorneys’ fees and costs which I or my child may have resulting, either directly or indirectly, from my child’s

participation in Alhuda Academy's voluntary athletic or extracurricular programs or activities.

I/We give permission for our son/daughter to participate in all school activities, and do forever release

Alhuda Academy and its teachers, staff, volunteers and agents from any and all actions, all known and

unknown personal injuries or property damage of said minor arising out of said activities, and also all claims

or right of action for damages which said minor has or hereafter may acquire.

I also have made arrangements to secure timely pick up of my child at the conclusion of each

scheduled program event, meeting, or practice. I also understand that the Late Fee policy will apply

By signing this Agreement, I/we acknowledge that we have read and understand this document and accept

the risk and responsibility of participation in interscholastic or other voluntary after school athletics.

Parent’s Signature: ________________________________________Date:______________

In the event of an emergency, I hereby certify that I am the parent/lawful guardian of

_______________________________________, and grant to Alhuda Academy, its employees and agents full authority to

take whatever action they may consider appropriate under the circumstances involved regarding the health

and safety of my child and authorize them to obtain emergency medical or dental services for my child, if

necessary, at my expense.

Parent’s Signature: ________________________________________Date:______________

Emergency Phone #:______________________________________

Committed to Excellence in Education that Builds Better Citizens and Better Muslims

Alhuda Academy is accredited by the New England Association for Schools and Colleges (NEASC)

General After School Program Registration - Waiver Form Page 2