School: HHS
School Year: 2024 - 2025
| Student name: {Student_Name} |
| Student Gender: {Gender} |
| Grade: {Grade} |
| Home Phone: {PG1_PrimaryPhone} |
| Parents'/Guardians' names: {PG1_Name} {PG2_Name} |
| Home address: {HomeAddressStreet}, {HomeAddressCity} {HomeAddressZip} |
| Parent/Guardian 1 Phone: {PG1_PrimaryPhone} |
| Parent/Guardian 1 Email: {PG1_Email} |
| Parent/Guardian 2 Phone: {PG2_PrimaryPhone} |
| Parent/Guardian 2 Email: {PG2_Email} |
| Name of other Emergency Contact: {EC_Name} |
| Emergency Contact Phone: {EC_Phone} |
Medical Conditions: {HealthNeedDetails}
INFORMED CONSENT & SPORTS INJURY RISK WARNING STATEMENT
By its very nature, competitive athletics can put students in situations in which serious, catastrophic, and perhaps fatal accidents could occur. By granting permission to your son/daughter to participate in athletic competition, a parent/guardian acknowledges that playing or practicing in any sport can be a dangerous activity involving MANY RISKS OF INJURY. Both the athlete and parent must understand that the dangers and risks of playing or practicing include but are not limited to: death, complete or partial paralysis, brain damage, serious injury to virtually all internal organs, bones, joints, ligaments, muscles, tendons, and other aspects of the skeletal system and potential impairment to other aspects of the body, general health and well-being. However, it is impossible to totally eliminate such incidents from occurring.
Because of the dangers of participating in sports, players may reduce the chance of injury by following coaches' instructions regarding playing techniques, training, equipment and other team rules, etc., both in competition and practice and agree to obey such instructions. Damaged equipment must be reported immediately. Even if all these requirements are met and even if the athlete is using excellent protective equipment, we understand that a serious, maybe even a fatal accident may occur.
INSURANCE REQUIREMENTS (Parents must also complete this section)
California law (Ed. Code Section 32221) requires every member of any interscholastic athletic team, as well as those associated directly with any interscholastic team, athletic event, including song and cheerleaders, team mascots, team manager, etc. to possess accidental bodily insurance providing at least $1,500 of scheduled medical and hospital benefits. Please check the box below if you have the required insurance coverage for your son or daughter.
Insurance status: {Insurance_Coverage}
Name of Medical Insurance Company: {HealthInsurance_Name}
Policy #: {HealthInsurance_Policy}
Group #: {HealthInsurance_Group}
UNDERSTANDING/AGREEMENT, CONSENT TO TREAT, & WAIVER/RELEASE OF LIABILITY
We the under-signed, have read and understand the Informed Consent and Risk Warning Statement above and we have met the insurance requirements as described above. We also certify that our child has received/will recieve the required Physical Examination by a licensed medical doctor, has/will be cleared to participate in school sports and activities for the upcoming school year, and the completed Physical Forms have been/will be submitted to the appropriate high school officials. In signing below, we grant our son/daughter permission to participate in extracurricular school sports/activities, to be released from school when required, and to travel to and/or ride as a passenger in a vehicle driven by another parent or coach to school-sponsored events. Lastly, we hereby authorize the coaches and other personnel of the Fremont Union High School District to act for me/us according to their best judgment in any emergency requiring medical attention for my/our son or daughter, and we hereby waive, release, and hold harmless, the Fremont Union High School District, its Officers, Agents, Employees, and Board Members from any and all liability while traveling to and from, and/or participating in school-sponsored activities.