Medical Treatment
I acknowledge that the District does not have any health insurance coverage which
would be applicable to my child’s participation. In the event of an injury, I hereby give
permission to the district or its agents, volunteers, or employees to seek medical
treatment for this child. In my absence, I hereby give permission to the physician
selected by the district or its employees to administer medical treatment, including
hospitalization, to my child.
Waiver of Liability
I do hereby waive and release the District, its agents, volunteers, and employees from
any claim or liability my child may have against them, including but not limited to
damages resulting from personal injury or death, or property damage, or losses of any
kind or nature caused by or resulting from my child’s participation in activities, whether
or not such injury, loss, or death was caused by negligence or from any other cause. I
hereby recognize that this acknowledgement and liability waiver form will remain in
effect for one year from the date signed and will cover my child during that time.

Name of Child (required)

Date of Birth (required)

Age (required)

Allergies (required)

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Parental Infromation

Parents Name (required)

Parents Phone Number (required)

Emergency Contact #1 (required)

Number (required)

Emergency Contact #2 (required)

Number (required)

Your Signature (required)

Confirm e-Signature

Review Electronic Records and Signatures Policy (required)

Read our Electronic Record and Signature Disclosure

I agree to use electronic records and signatures

Date (required)

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