Gwynedd Mercy Academy

SPORTS PERMISSION FORM

Each student in fourth through eighth grade interested in participating in any sports program at Gwynedd-Mercy Academy must have the following consent form completed, signed by a parent or legal guardian and returned to the appropriate Athletic Director before he/she can participate.

Boys and girls in fourth grade may participate in instructional field hockey, soccer, basketball, lacrosse and baseball. The one-time events, cross-country, swimming, and track meets, are open to all boys and girls in grades four through eight. Girls and boys in fifth through eighth grade are eligible for Junior Varsity and Varsity teams.

ATHLETIC CHOICES: Please circle and initial all the sports your child could possibly participate in throughout the school year.

BASEBALL ______BASKETBALL ______CHEERLEADING ______

CROSS COUNTRY ______FIELD HOCKEY ______FOOTBALL ______

INTRAMURAL BASKETBALL ______LACROSSE ______

SOCCER ______SOFTBALL ______SWIMMING ______

TRACK ______

I/we, the parent(s)/guardian(s) of ______

request that the school allow my/our child to participate in the above circled and initialed sport(s) at Gwynedd-Mercy Academy. We hereby release and save harmless Gwynedd-Mercy Academy Elementary, and any and all employees, coaches, and volunteers from any and all liability for any and all harm arising to our son/daughter as result of participating in the sports program. I/we have read the above information and I/we give my/our child permission to participate in the Gwynedd-Mercy Academy after-school sports program.

(Signature of Parent/Guardian) (Date)

Child’s Homeroom ______