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    Regiform

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    api-275082715
    This document is a play permission form for a student. It contains the student's name, contact information for parents/guardians, emergency contacts, health information, and a liability waiver. The parent/guardian must sign acknowledging they understand the risks and waiving the school/parish's liability if the student is injured while participating. It also notes that students in grades 7-8 must attend mandatory practices and parents will be charged extended day fees if students are not picked up on time.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd

    Regiform

    Uploaded by

    api-275082715
    113 views1 page
    This document is a play permission form for a student. It contains the student's name, contact information for parents/guardians, emergency contacts, health information, and a liability waiver. The parent/guardian must sign acknowledging they understand the risks and waiving the school/parish's liability if the student is injured while participating. It also notes that students in grades 7-8 must attend mandatory practices and parents will be charged extended day fees if students are not picked up on time.

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    This document is a play permission form for a student. It contains the student's name, contact information for parents/guardians, emergency contacts, health information, and a liability waiver. The parent/guardian must sign acknowledging they understand the risks and waiving the school/parish's liability if the student is injured while participating. It also notes that students in grades 7-8 must attend mandatory practices and parents will be charged extended day fees if students are not picked up on time.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    113 views1 page

    Regiform

    Uploaded by

    api-275082715
    This document is a play permission form for a student. It contains the student's name, contact information for parents/guardians, emergency contacts, health information, and a liability waiver. The parent/guardian must sign acknowledging they understand the risks and waiving the school/parish's liability if the student is injured while participating. It also notes that students in grades 7-8 must attend mandatory practices and parents will be charged extended day fees if students are not picked up on time.

    Copyright:

    © All Rights Reserved
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    Download as pdf or txt
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    Play Permission Form

    Students Name:
    Home Phone:

    Grade

    Home Room

    Cell Phone

    Parent(s) names:
    In the case of an emergency we will contact the above numbers first.
    Please put someone other than you in the section below a neighbor, grandparent, relative etc.
    Name:

    Phone:

    Name:

    Phone:

    HEALTH INFORMATION
    Physician:

    Phone #:

    Dentist:

    Phone #:

    Any Allergy/Health Information we should be aware of:


    Saint Michael School/Parish of North Andover, MA (the Parish). Acknowledgement and Assumption of Risk
    The undersigned participant, parent and/or legal guardian, does hereby acknowledge that I am or he/she is aware of the dangers and
    risks to persons and property by participating in this trip. Nevertheless, I or the undersigned parent and/or legal guardian, voluntarily
    elect to participate in this activity with knowledge of the danger involved, and hereby agree to accept and assume any and all risk or
    property damage, personal injury or death.
    Medical Authorization, Indemnification and Waiver of Liability
    In consideration for being allowed to voluntarily participate in the above referenced event, I hereby:
    a) Consent to receive medical treatment, which may be deemed advisable in the event of injury, accident or illness during this activity
    or event. This release, indemnification, and waiver shall be construed broadly to provide a release, indemnification, and waiver to
    the maximum extent permissible under applicable law;
    b) Agree to defend, indemnify, and hold harmless the Parish/School and the Roman Catholic Archbishop of Boston, a Corporate Sole,
    and its agencies, officers, and employees from and against any and all claims of any nature including all costs, expense and
    attorneys fees, which in any manner result from actions during this activity or event; and
    c) Waive and release forever the Parish/School and the Roman Catholic Archbishop of Boston, a Corporate Sole, and its agencies,
    officers, and employees from any and all liability for death, disability, personal injury, property damages, property theft, or claims
    of any nature which may hereafter accrue as a direct or indirect result of the participation in the activity or event.
    Further, I affirm that I am at least 18 years of age and am freely signing this agreement. I have read this form and fully understand that
    by signing this form I am giving up legal rights and/or remedies that may otherwise be available regarding any losses sustained as a
    result of participating. I agree that if any portion is held invalid, the remainder will continue in full legal force and effect.
    All students not picked up after practice will be taken to Extended Day. Please be aware that you will be responsible for all fees
    incurred. Attendance at practices is important and mandatory for students in Grades 7 and 8.
    Signature of Parent/Guardian: ___________________________________________
    In the event that I am unable to pick-up my child after practices, I authorize the following people to transport my child:

    Name

    Name

    Phone

    Phone

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