Lansing Eastern High School Parent Consent Form
Lansing Eastern High School Parent Consent Form Before participating on any athletic team at Eastern High School, the student must return this completed form to the athletic department to be kept on file by the Athletic Director for future team participation during the school year. TO BE FILLED OUT BY THE STUDENT ________________________________________________________ (FIRST NAME)
(LAST NAME)
Present address: ______________________
City _________________
Place of Birth: City_____________________ ___
County_________________ State_______________
Grade_____
Student Signature_________________________________
Sport(s) __________________
Zip________________
TO BE FILLED OUT BY PARENT and/or GUARDIAN I hereby certify that the above-named student may take part in any of the sports circled from the list below and while at Eastern High School during the current school year. BASEBALL
BASKETBALL
CHEERLEADING
CROSS COUNTRY
FOOTBALL
GOLF
GYMNASTICS
POM PONS
SOCCER
SOFTBALL
SWIMMING
TENNIS
TRACK & FIELD
VOLLEYBALL
WRESTLING
WARNING: Athletic activities involving motion, heights or contact create the possibility of serious injury, including permanent paralysis and even death from landing, falling or collision on the head, neck or spinal column. You assume the risk of a serious injury with participation in sport activities, even where protective equipment is provided. Thus risk can be significantly reduced by the athlete: 1. 2. 3. 4. 5.
Knowing his/her limitations Following progressive learning Properly using sports equipment Properly wearing protective equipment Always following directions of and/or consulting with the coach.
I will not hold Eastern High School responsible for injuries that the above-named student may sustain while engaging in the above noted sports or while traveling to or from athletic contests. I also certify that Sections I (Student Information) is completely correctly to the best of my knowledge. Family Insurance__________________________________ Policy Number __________________________ Date_____________ Signature of Parent and/or Guardian_________________________________________
ALL ATHLETIC EQUIPMENT AND UNIFORMS ARE ISSUED BY EASTERN HS ON A LOAN OR RENTAL BASIS, AND REMAIN THE PROPERTY OF EASTERN HS. EQUIPMENT AND UNIFORMS MUST BE RETURNED IMMEDIATELY AT THE CONCLUSION OF PARTICIPATION IN THAT SPORT. FAILURE TO RETURN EQUIPMENT OF UNIFORMS WILL RESUL IN THE ABOVE NAMED STUDENT/PARENT AND/OR /GUARDIAN TO MAKE FULL RESTITUTION.
(LAST NAME)
Present address: ______________________
City _________________
Place of Birth: City_____________________ ___
County_________________ State_______________
Grade_____
Student Signature_________________________________
Sport(s) __________________
Zip________________
TO BE FILLED OUT BY PARENT and/or GUARDIAN I hereby certify that the above-named student may take part in any of the sports circled from the list below and while at Eastern High School during the current school year. BASEBALL
BASKETBALL
CHEERLEADING
CROSS COUNTRY
FOOTBALL
GOLF
GYMNASTICS
POM PONS
SOCCER
SOFTBALL
SWIMMING
TENNIS
TRACK & FIELD
VOLLEYBALL
WRESTLING
WARNING: Athletic activities involving motion, heights or contact create the possibility of serious injury, including permanent paralysis and even death from landing, falling or collision on the head, neck or spinal column. You assume the risk of a serious injury with participation in sport activities, even where protective equipment is provided. Thus risk can be significantly reduced by the athlete: 1. 2. 3. 4. 5.
Knowing his/her limitations Following progressive learning Properly using sports equipment Properly wearing protective equipment Always following directions of and/or consulting with the coach.
I will not hold Eastern High School responsible for injuries that the above-named student may sustain while engaging in the above noted sports or while traveling to or from athletic contests. I also certify that Sections I (Student Information) is completely correctly to the best of my knowledge. Family Insurance__________________________________ Policy Number __________________________ Date_____________ Signature of Parent and/or Guardian_________________________________________
ALL ATHLETIC EQUIPMENT AND UNIFORMS ARE ISSUED BY EASTERN HS ON A LOAN OR RENTAL BASIS, AND REMAIN THE PROPERTY OF EASTERN HS. EQUIPMENT AND UNIFORMS MUST BE RETURNED IMMEDIATELY AT THE CONCLUSION OF PARTICIPATION IN THAT SPORT. FAILURE TO RETURN EQUIPMENT OF UNIFORMS WILL RESUL IN THE ABOVE NAMED STUDENT/PARENT AND/OR /GUARDIAN TO MAKE FULL RESTITUTION.
