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NEPN/NSBA Code: JJIB-E (NHS) MSAD #37 POLICY PLAYER’S ACKNOWLEDGEMENT
I, the
undersigned, have read and understand fully the Athletic Code/Awards Criteria
and the Drug and Alcohol Use by Students Policy/Procedure (JICH and JICH-R) and agree to abide by them. Player’s Signature:____________________ Date:
_______________ SPORT: ________________________________ 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.
I 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, the Drug and Alcohol Use by Students Policy/Procedure (JICH and JICH-R) and the
information above and agree to abide by all of them. We have medical insurance with
______________________(company). The
policy number is:
____________________ Parent’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
present school year. COMMENTS/RESTRICTIONS: Physician’s
Signature:____________________
Date: _______________ Approved: November 29, 2000 |
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