2022-23 High School Athletic Parental Consent Form*

2022-23 High School Athletic Parental Consent Form
There are 3 sections. Be sure to complete all sections and fill out all fields.

Make sure to hit the Submit button upon completion.

You will receive 2 confirmation emails.

The first email will confirm that your forms were successfully submitted and under review.

The second email from the athletic department grants approval for your child’s participation. OR If there is an error, the athletic department will also reach out to you.
General Information
Student Name*

First NameLast Name
Student Grade*
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.

Interscholastic Athletic Parental Consent
I hereby give my consent for my child {name4} to participate on the {typeA9} team 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. While the coaching staff and other responsible school officials will do everything within reason to protect my child against injury, including the provision for appropriate equipment, safe facilities and training designed to reduce the impact of accidents, I understand that injuries may occur and on a very rare occasion may be serious and disabling. I am also aware that athletic participation will involve travel and that all travel involves some risk of serious injury.

My child is required to attend all team practices and contests, and attendance at practices will be reflected in playing time in games and tournaments. I am aware that school equipment is issued to my child for participation. The equipment is my child's responsibility and must be returned promptly upon request. Reimbursement will be expected for loss or destruction beyond ordinary wear and tear.

My child has agreed to abide by the guidelines set by the Athletic Department. 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 interscholastic athletic activities. 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 consents 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 to release, medical information regarding my son/daughter to the extent necessary for medical care. I also agree 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.
Signature*

Clear

Medical Certificate for Interscholastic Participation
I hereby acknowledge that I may not be available to provide consent for medical treatment and dispensing of any medication in the event that my child, {name4}, becomes sick or is injured during any athletic participation authorized below. In the event that I am not able to give such consent, it is my desire to have the best available medical treatment for my child. I here authorize representatives of the Abraham Joshua Heschel School to act on my behalf with respect to any required medical treatment decisions and consents, until such time as I am able to provide these.

Any qualified medical personnel are hereby notified that this authorization is currently in effect and such personnel are directed to act upon such authorization without delay. I understand that every effort will be made to contact parents, the child’s physician and/or the emergency number given by me on this form.
Signature*

Clear

Travel & Dismissal Permission
This is to advise you that athletic participation will include travel by train, in private buses or vans and taxicabs. No travel will be permitted other than in these types of vehicles but all travel inherently includes risk of possible injury. Please place your signature on the appropriate line below.
I give my child permission to:

travel to and from games via private bus/van, faculty cars or train.exit the team bus at a cross street (convenient to home) when returning.travel to and from local games via taxi or car service. (I understand that a faculty member will notalways be present to hail or ride in the taxi with students)
I give my son/daughter permission to be dismissed directly from practices or games, (I understand that he/she may be leaving these sites alone or with friends and unaccompanied by an adult) from sites in:*

ManhattanBrooklynQueensBronxNew JerseyI do not give permission for self-dismissal from any site. I will pick up my child from practices or games.
Should be Empty:

2022-23 High School Athletic Parental Consent Form

General Information

Interscholastic Athletic Parental Consent

Medical Certificate for Interscholastic Participation

Travel & Dismissal Permission