2022-23 Middle School Athletic Parental Consent Form

Student Name*

First NameLast Name

Student Grade*

678

Sport*

Parent/Guardian Name*

First NameLast Name

Parent/Guardian Email*

example@example.com

Parent/Guardian Phone Number*

Please enter a valid phone number.

Emergency Contact Details:

Please provide the information of an alternate person who may be contacted in case of an emergency.*

First NameLast Name

Emergency Contact Relation*

Primary Emergency Contact Phone Number*

Please enter a valid phone number.

Secondary Emergency Contact Phone Number

Please enter a valid phone number.

PARENT CONSENT: I hereby give my consent for my child {name4} to participate in the intramural/interscholastic {typeA9} (sport) program sponsored by The Abraham Joshua Heschel School. I understand that interscholastic sports are a part of a broad extracurricular program designed to teach students certain skills and reinforce concepts of self-worth, cooperative effort and ethical decision making. I also understand that my child has agreed to abide by the guidelines set by the Athletic Department. I understand that violations of team/school policy may result in appropriate intervention including warnings, meetings, and dismissal from the team. I also understand that it is necessary for my child to have an approved medical certificate for school competition on file in the school before trying out, practicing or competing in intramural/interscholastic athletic activities. While the coaching staff and other responsible school officials will do everything within reason to protect my child against injury, I understand that injuries may occur and on a very rare occasion may be serious. I understand that in the event that my child becomes sick, or receives an injury during athletic participation, all reasonable efforts will be made to contact me and obtain any required consent for medical care. In situations where I cannot or be contacted for specific consent to treatment, and such delay creates risk to my child's life or health, I hereby authorize the school representatives to obtain appropriate medical care and treatment for my child including temporary pain relief to the extent deemed medically appropriate by the treating physician. I also authorize the school representatives to receive and release medical information regarding my child to the extent necessary for medical care and to inform the school of any change in my child's medical or physical condition which develops or is discovered at any time after the date this document is signed. I am also aware that athletic participation may involve travel for practices and games. All participants are required to travel with their teams to and from all contests. Please check the conditions that will apply to this student for dismissal from practices and games.

Please check the conditions that will apply to this student for dismissal from practices and games.

Student has permission to go home independently from the Heschel School building.Student has permission to go home independently from Meet Sites or Away Games.

* Any deviation from these procedures will only be allowed if specified on a signed note from a parent/guardian.

Signature*

Clear

Date*

Date