Physical Activities Acknowledgement and Assumption of Risk and Release 2023-24

Physical Activities Acknowledgement and Assumption of Risk and Release 2023-24

This form needs to be updated annually. You may do one form for all your children at River Grove.
Student/Participant 1 Name*

First NameLast Name
Student/Participant 1 Grade for 2023-24*
Student/Participant 2 Name

First NameLast Name
Student/Participant 2 Grade for 2023-24
Student/Participant 3 Name

First NameLast Name
Student/Participant 3 Grade for 2023-24
Student/Participant 4 Name

First NameLast Name
Student/Participant 4 Grade for 2023-24
Your student (the “participant”) will be participating in physical activities associated with River Grove. Physical activities require each participant’s parent or guardian to sign this acknowledgment and assumption of risk and release.

By signing this document, you:
1. Acknowledge that injury may result from the participant’s participation in the physical activity;
2. Assume the risk of and release and hold River Grove Elementary School harmless from and against any and all liability for any physical or other injury or harm suffered by the participant during or as a consequence of participating in physical activity; and
3. Acknowledge that you have carefully read, understand, and hereby agree to the above, and acknowledge that this agreement shall be binding on you (named below), your spouse, children, legal representatives, heirs, successors and assigns.
Exceptions:

If your child should be exempted from specific physical activity due to a medical condition or parent preference, please describe here. If the activity is part of the regular curriculum (and not optional, such as sledding), please provide a note signed by a physician.
Add any exceptions here:
Parent/Guardian Signature:
Sign and date (if this electronic signature doesn't work for you, please print and sign the hard copy and return to the school office)

Clear
Full name used in the signature above *
Today's Date

MonthDayYear
Parent Email*
example@example.com
Should be Empty: