Summer P.E. Parent Consent Form

Parent Acknowledgement, Release, Permission & Consent Form

I grant my child (name above) permission to take part in the Walsh Jesuit High School sponsored activity named above. While I understand that every effort is made for activities to be safe, I acknowledge that any activity of this sort involves a degree of risk of injury or illness, and that my child is participating in the activity at his/her own risk. I represent that my child has had such medical physical examination as I deem necessary to assure that he/she is physically able to participate in this activity. I also understand that my child must adhere to all safety rules and regulations or be excluded from participation in this activity. I give my consent and do hereby authorize the athletic trainer or his designate at Walsh Jesuit High School to secure any and all necessary medical treatment. I agree to be financially responsible for the reasonable cost of such assistance and/or treatment. I understand that an attempt will be made to contact the parent before treatment is initiated. If a parent cannot be reached, I authorize the attending physician to render any and all medical care which he/she deems necessary. My child and I, in consideration of being permitted to participate in this activity, assume all the risks associated with participation in this activity, and specifically release, discharge, indemnify and hold harmless Walsh Jesuit High School, and any other persons or parties connected with this activity in any way whatsoever, jointly and severally, from and against any and all blame or liability (including negligence) for any injury, illness, misadventure, harm, loss, inconvenience or damage to person or property sustained as a result of taking part in this activity and all activities and events associated with it.
Medical Information
(Area Code) XXX-YYYY
(Area Code) XXX-YYYY
Please identify any relevant medical history (e.g. allergies, medications, or impairments) to which a physician treating your child should be alerted.