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NEPN/NSBA Code: JJIB-E (Elem) MSAD #37 POLICY PLAYER’S ACKNOWLEDGEMENT
I, the undersigned, have read and fully understand the Athletic Code and agree to abide by it. ______________________________ ________________________ Player’s Signature Date PARENT’S CONSENT AND ACKNOWLEDGEMENT I give my consent for _____________________ to participate in interscholastic athletics or intramurals. I authorize the school and its employees to act in my place in all respects. This permission shall include, but not be limited to, obtaining emergency medical care. We acknowledge the fact that any athlete can be seriously injured while participating in intramurals, as well as, interscholastic athletics. I furthermore release and indemnify the school and the district from any claim or damage arising from participation in this activity or from related travel. We/I the undersigned, have read and agree to the Athletic Code and the information above and agree to abide by it. We have medical insurance with __________________(company) The policy number is: ____________________________ ______________________________ ________________________ Parent/Guardian’s Signature Date PHYSICIAN’S STATEMENT ___________________________ has received a thorough physical examination. I find him/her ¸ fit ¸ unfit to participate in interscholastic athletics and intramurals during the school year. COMMENTS/RESTRICTIONS: ______________________________ ________________________ Physician’s Signature Date Approved: November 29, 2000 |
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