PERMISSION TO PARTICIPATE IN   

INTER-SCHOLASTIC ATHLETICS

 

The answers provided in the Health History Questionnaire Forms are correct.  I understand that any misrepresentation of the information contained herein will result in the student being denied the opportunity to participate.

I herby give my consent for:

_________________________, Grade  _____  to participate in ____________________,

(Student's Name - Printed)                                                             (Sport-Printed)

 

___________________________________                           _____________________,

(Address and Town)                                                                (Phone Number)

 

for Thompson Middle School conducted by the school against other schools and within the school.  Parents and guardians should be aware that such activity involves the potential for injury, which is inherent in all sports.  I/we acknowledge that even within the best coaching, use of the most advanced protective equipment and strict observation of rules, injuries are still a possibility.  On rare occasions these injuries can be so severe as to result in total disability, paralysis, or event death.  I/we acknowledge that I/we have read and understand this warning. I/we shall assume all responsibility and expense for any injury received in practice or participation.  I give my permission for my son/daughter to be evaluated and treated by the school trainer and/or team physician should such service be necessary.

 

__________________________________                                ____________________

(Parent/Guardian Signature )                                                      (Date)

 

__________________________________                              _____________________

(Address and Town)                                                                 (Phone Number)

 

Eligibility for participation in sports is determined by the student having had:

 

1. a Physical examination done within 365 days of the first day of practice signed and stamped by the attending physician on the NJSLAA issued Athletic Physical Form.

 

2. a completed Health History Questionnaire dated no longer than 60 days prior to the first day of practice for each sport.

 

3. a completed Permission to Participate Form for each sport.