West Athletics Participation Waiver and Emergency Information Form

Sturgis Public Charter School

Sturgis West Athletic Department

Tel.: 508-771-2780Ext. 407 E-mail:

West Athletics Participation Waiver and Emergency Information Form

This form must be completed alongside the Google doc sign up form. Please complete this form and return it with a check / cash for the participation fee by the deadline set on http://sturgischarterschool.org/athletics/WestAthletics.html

Name: First ______Last______Grade_____(2016-17)

Fall Sport______

Winter Sport______

Spring Sport______

Participation in athletics is inherently dangerous. Even when all reasonable precautions are taken, students can be, and indeed, may be injured. All students participate in athletics voluntarily with permission of their parents or guardians. Along with this participation, the students and their parents/guardians accept the inherent risks to which the students expose themselves to.

Emergency Contact Info (please list at least two people)

Contact 1 Name______Relationship______

Cell Phone______Work Phone______

Home Phone______

Contact 2 Name______Relationship______

Cell Phone______Work Phone______

Home Phone______

·  I have read the online athletic handbook and agree with the terms and conditions.

·  I have read and I understand the above waiver concerning participation in interscholastic athletics for Sturgis Charter Public School and give permission for my child to participate in this athletic season.

______

Student Signature Parent/Guardian Signature Date

$100 participation fee attached (only for the current season)

New physical form attached (if physical is out of date). Physical are valid for13 monthsfrom the date of examination. Please contact the athletic office if you are not sure. (Grade 9 – Please attach a copy of your physical regardless if you are playing your first sport at Sturgis West).